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Sample records for lateral neck dissection

  1. Neck dissection - discharge

    Science.gov (United States)

    Radical neck dissection - discharge; Modified radical neck dissection - discharge; Selective neck dissection - discharge ... 659-665. Robbins KT, Samant S, Ronen O. Neck dissection. In: Flint PW, Haughey BH, Lund V, et ...

  2. [Spinal accessory nerve and lymphatic neck dissection].

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    Pinsolle, V; Michelet, V; Majoufre, C; Caix, P; Siberchicot, F; Pinsolle, J

    1997-09-01

    Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.

  3. Nodal yield in selective neck dissection

    DEFF Research Database (Denmark)

    Norling, Rikke; Therkildsen, Marianne H; Bradley, Patrick J

    2013-01-01

    The total lymph node yield in neck dissection is highly variable and depends on anatomical, surgical and pathological parameters. A minimum yield of six lymph nodes for a selective neck dissection (SND) as recommended in guidelines lies in the lower range of the reported clinical nodal yields...

  4. Spinal accessory nerve function following neck dissection.

    Science.gov (United States)

    Zibordi, F; Baiocco, F; Bascelli, C; Bini, A; Canepa, A

    1988-01-01

    Spinal accessory nerve (SAN) function was evaluated by electromyography (EMG) and muscle testing in 36 patients who underwent neck dissection with SAN preservation. The results emphasized that SAN function was relatively good after conservative neck surgery. Muscle testing findings showed better function than did EMG findings. After surgery the trapezius muscle functioned more efficiently than the sternocleidomastoid (SCM) muscle probably because of the more traumatic surgical handling of both the SCM muscle and its SAN branch. In order to obtain the functional advantages of SAN preservation, the authors suggest that the conservative procedure in radical neck dissection be used whenever warranted by oncologic diagnosis.

  5. Neck dissection: then and now.

    NARCIS (Netherlands)

    Ferlito, A.; Rinaldo, A.; Silver, C.E.; Shah, J.P.; Suarez, C.; Medina, J.E.; Kowalski, L.P.; Johnson, J.T.; Strome, M.; Rodrigo, J.P.; Werner, J.A.; Takes, R.P.; Towpik, E.; Robbins, K.T.; Leemans, C.R.; Herranz, J.; Gavilan, J.; Shaha, A.R.; Wei, W.I.

    2006-01-01

    The significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a syst

  6. Jugular neck dissection for NO neck supraglottic carcinoma

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    Petrović Željko

    2004-01-01

    Full Text Available Appropriate management of patients with supraglottic laryngeal carcinoma and negative findings in the neck is still controversial. A prospective and retrospective study comprised 193 patients who were treated primary surgically between 1976 and 1993. They all had clinically and ultrasound negative findings on the neck (NO. Supraglottic carcinomas usually spread regionally. Metastases develop in the jugular group, between level II-IV. The incidence of metastases has been reported to vary from 12 to 62.5%. The size and localization of the primary tumor, its histological grade, genotype of the malignant cells, imunological and other elucidated factors can all affect the incidence of regional spread. AIM Aim of this study was to specify the incidence of occult cervical metastases; to analyze the distribution of occult metastases related to tumor localization; to specify the distribution of occult metastases related to local spread; to analyze the distribution of occult metastases according to localization in the neck. RESULTS All patients had primary surgery of primary tumor and bilateral jugular, selective neck dissection at the level II-IV with histological examination of removed lymphoid tissue. Out of 193 patients, metastatic deposits were detected in 35(18%. Occult metastases were found in patients with carcinoma of the epilarynx in 19% (14/72 of cases, and in 17% (21/121 patients with carcinoma of the supraglottis excluding the epilarynx. This difference in frequency is not statistically significant. The incidence of occult metastases in epilaryngeal tumors did not depend on the degree of local spread. Even relatively small tumors (T1 and T2 yielded occult metastases in 33% (5/15, and 24% (6/25 of patients, respectively. In patients with T1 tumors localized at the supraglottis, excluding the epilarinx, occult metastases were not found. In the supragiottis excluding the epilarynx increased local spread was associated an increase of occult

  7. Planned Neck Dissection Following Radiation Treatment for Head and Neck Malignancy

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    J. F. Dautremont

    2012-01-01

    Full Text Available Introduction. Optimal therapy for patients with metastatic neck disease remains controversial. Neck dissection following radiotherapy has traditionally been used to improve locoregional control. Methods. A retrospective review of 28 patients with node-positive head and neck malignancy treated with planned neck dissection following radiotherapy between January 2002 and December 2005 was performed to assess treatment outcomes. Results. Median interval to neck dissection was 9.6 weeks with a median number of 21 + 9 lymph nodes per specimen. Ten of 31 (32% neck dissection specimens demonstrated evidence of residual carcinoma. Overall survival at two years was 85%; five-year overall survival was 65%. Concurrent chemotherapy did not impact the presence of residual neck disease. Conclusion. Based on the frequency of residual malignancy in the neck of patients treated with primary radiotherapy, a planned, postradiotherapy neck dissection should be strongly advocated for all patients with advanced-stage neck disease.

  8. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

    Science.gov (United States)

    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  9. Fenestrated internal jugular vein: a rare finding in neck dissection.

    Science.gov (United States)

    Moreno-Sánchez, M; Hernández Vila, C; González-García, R; Monje, F

    2015-09-01

    Fenestration of the internal jugular vein (IJV) is an extremely rare phenomenon. An 85-year-old woman was referred to our department with T2N0M0 squamous cell carcinoma of the right floor of the mouth. The patient underwent local resection, an ipsilateral modified type 3 radical neck dissection, and microsurgical reconstruction. During neck dissection, a fenestration was observed in the middle of the IJV. No structure passed through the fenestration. Such anatomical variations are rare, but clinicians and surgeons should be aware of them in order to avoid damage to the important vascular structures, especially if a neck dissection is performed.

  10. Robotic thyroidectomy and cervical neck dissection for thyroid cancer.

    Science.gov (United States)

    Paek, Se Hyun; Kang, Kyung Ho

    2016-06-01

    A robotic approach for thyroid surgery was developed to overcome the limitations of endoscopic thyroidectomy and provide many technical advantages. This approach facilitates the surgeon's control through a magnified three-dimensional view, decreased tremor, and freedom of motion with articulated instruments. Robotic thyroidectomy is safe and technically feasible in patients with well-differentiated, low-risk thyroid cancer. Furthermore, robotic thyroidectomy may become a good surgical alternative option for patients with more advanced thyroid cancer. Our modified bilateral axillo-breast approach (BABA) for central and lateral cervical neck lymph node (LN) dissection has yielded excellent surgical outcomes as an open procedure. The incorporation of robotics in thyroid cancer surgery will continue to evolve, and the surgical indications for robotic thyroidectomy will continue to expand. Further analyses that include long-term outcomes and randomized comparative trials remain important.

  11. Cost-effectiveness of selective neck dissection versus modified radical neck dissection for treating metastases in patients with oral cavity cancer: A modelling study.

    NARCIS (Netherlands)

    Govers, T.M.; Patel, S.; Takes, R.P.; Merkx, T.; Rovers, M.; Grutters, J.

    2015-01-01

    BACKGROUND: Choosing between a more or less extensive neck dissection implies a tradeoff between survival, quality of life, and costs. The purpose of this study was to determine if selective neck dissection (level I-III or I-IV) is cost-effective compared with modified radical neck dissection (level

  12. Athermal bladder neck dissection during robot-assisted radical prostatectomy

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    Fabrizio Dal Moro

    2014-06-01

    Full Text Available Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at the prostato-vesical junction, contributing to earlier return of urinary continence. The purpose of this video is to show an anatomical athermal dissection of BN during RARP.Materials and Methods After incision of endopelvic fascia and anterior defatting, the morphology of prostate not only laterally, but also at the level of bladder-prostatic junction is well visualized. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of BN. A cold section of the preserved BN permits the complete preservation of integrity of this sphincteric structure.Results With this technique we preserve the longitudinal fibres of BN, allowing the sparing of the sphincteric mechanism of BN. The finding of a difficult athermal dissection of these plans may make you suspect the presence of an infiltration, suggesting to sacrifice BN in order to avoid a positive surgical margin. In our series no increase of PSM has been recorded using this technique.Conclusions This surgical technique preserving the natural BN mechanism appears to improve urinary continence, allowing at the same time an easy identification of a neoplastic infiltration.

  13. Prediction of Neck Dissection Requirement After Definitive Radiotherapy for Head-and-Neck Squamous Cell Carcinoma

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    Thariat, Juliette [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Department of Radiation Oncology/IBDC CNRS UMR, Cancer Center Antoine-Lacassagne, University Nice Sophia-Antipolis, Nice, Cedex 2 (France); Ang, K. Kian; Allen, Pamela K. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ahamad, Anesa [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); University of the West Indies, St. Augustine (Trinidad and Tobago); Williams, Michelle D. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Myers, Jeffrey N. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Department of Cancer Biology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); El-Naggar, Adel K. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ginsberg, Lawrence E. [Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Rosenthal, David I. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Glisson, Bonnie S. [Department of Thoracic/Head and Neck Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Morrison, William H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S., E-mail: agarden@mdanderson.org [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

    2012-03-01

    Background: This analysis was undertaken to assess the need for planned neck dissection in patients with a complete response (CR) of involved nodes after irradiation and to determine the benefit of a neck dissection in those with less than CR by tumor site. Methods: Our cohort included 880 patients with T1-4, N1-3M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received treatment between 1994 and 2004. Survival curves were calculated by the Kaplan-Meier Method, comparisons of rates with the log-rank test and prognostic factors by Cox's proportional hazard model. Results: Nodal CR occurred in 377 (43%) patients, of whom 365 patients did not undergo nodal dissection. The 5-year actuarial regional control rate of patients with CR was 92%. Two hundred sixty-eight of the remaining patients (53%) underwent neck dissections. The 5-year actuarial regional control rate for patients without a CR was 84%. Those who had a neck dissection fared better with 5-year actuarial regional control rates of 90% and 76% for those operated and those not operated (p < 0.001). Variables associated with poorer regional control rates included higher T and N stage, non-oropharynx cancers, non-CR, both clinical and pathological. Conclusions: With 92% 5-year neck control rate without neck dissection after CR, there is little justification for systematic neck dissection. The addition of a neck dissection resulted in higher neck control after partial response though patients with viable tumor on pathology specimens had poorer outcomes. The identification of that subgroup that benefits from additional treatment remains a challenge.

  14. Recurrence and survival after neck dissections in cutaneous head and neck melanoma

    DEFF Research Database (Denmark)

    Andersen, Peter Stemann; Chakera, Annette Hougaard; Thamsborg, Andreas Key Milan

    2014-01-01

    INTRODUCTION: An important prognostic factor in head and neck melanoma is the status of the regional lymph nodes since the presence of metastatic disease in the nodes greatly aggravates the prognosis. There is no consensus on the surgical treatment algorithm for this group. Our aim was to study...... if there is a difference in nodal recurrence and survival after radical, modified or selective neck dissection. METHODS: A total of 57 patients treated for regional meta-stases of head and neck melanoma were analysed retrospectively with respect to type of neck dissection, use of sentinel node biopsy, nodal recurrence...

  15. Elective Neck Dissection in Patients With Head and Neck Adenoid Cystic Carcinoma

    DEFF Research Database (Denmark)

    Amit, Moran; Na'ara, Shorook; Sharma, Kanika

    2015-01-01

    BACKGROUND: Adenoid cystic carcinoma (ACC) accounts for 3-5 % of all head and neck malignancies. Investigations of outcomes from elective neck dissection (END) for patients with ACC are sparse. This study aimed to assess the impact of END on the survival of patients with ACC. METHODS: This retros......BACKGROUND: Adenoid cystic carcinoma (ACC) accounts for 3-5 % of all head and neck malignancies. Investigations of outcomes from elective neck dissection (END) for patients with ACC are sparse. This study aimed to assess the impact of END on the survival of patients with ACC. METHODS......: This retrospective multicentered study investigated 270 patients who underwent neck dissection. A multivariate analysis assessed associations of clinical and histopathologic characteristics with survival outcomes. RESULTS: The primary tumor sites included the oral cavity in 250 patients (55 %), the major salivary...

  16. Rational radical neck dissection for oral cancer

    Institute of Scientific and Technical Information of China (English)

    李龙江; 温玉明; 王昌美; 王莉娟

    2003-01-01

    Lymphatic metastasis is the most commonly seen route for the spread of malignant epithelial tumors. Oral cancers derived from epithelial tissue occur more often in the head and neck regions with a high lymphatic metastasis rate. According to reports from Chinese researchers, the lymphatic metastasis rate of oral cancer could be as high as 40%, and clearing those involved lymph nodes in neck is one of the most important methods to treat the disease.

  17. Complications in Neck Dissection 10 years ex-perience with 268 cases in the Cancer Institute

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    M.K. OSKOUI

    1973-07-01

    Full Text Available Immediate and late post operative complications or radical Neck Dissection were discussed. Preventive measures and the treatment of each were mentioned briefly. Our 10 years experience with complications or neck dissection in the Cancer Institute was presented.

  18. Risk of marginal mandibular nerve injury in neck dissection

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Sørensen, Christian Hjort

    2012-01-01

    The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons...... in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7......% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered...

  19. INDICATIONS FOR RADIOTHERAPY AFTER NECK DISSECTION

    NARCIS (Netherlands)

    Strojan, Primoz; Ferlito, Alfio; Langendijk, Johannes A.; Silver, Carl E.

    Up-front surgery and postoperative radiotherapy constitute a well-recognized treatment concept for locally or regionally advanced squamous cell carcinoma of the head and neck. This "treatment package" is further intensified with the concomitant application of chemotherapy during irradiation when

  20. Incidental cervical metastases from thyroid carcinoma during neck dissection.

    Science.gov (United States)

    Périé, S; Torti, F; Lefevre, M; Chabbert-Buffet, N; Jafari, A; Lacau St Guily, J

    2016-12-01

    To quantify and discuss the prevalence of unsuspected thyroid lymph node metastases discovered in specimens from neck dissection for head and neck squamous cell carcinoma (HNSCC) and discuss the impact on patient management. Retrospective study between May 2004 and January 2007. University hospital. Pathological analysis of cervical lymph node dissection performed during surgery for HNSCC in a total of 349 neck dissections in 266 consecutive patients. Twenty-one patients showed metastatic lymph nodes from thyroid cancer (prevalence 7.9%): 13 cases were metastatic from a papillary thyroid carcinoma and 8 cases from a follicular carcinoma. In 5 of the 21 patients, classical dissection was associated to recurrent nerve dissection and unilateral lobectomy; no thyroid carcinoma was found. Thirteen patients received radiotherapy for HNSCC. Follow-up comprised annual ultrasonographic examination of the neck and thyroid in these 21 patients. Total thyroidectomy was decided on in 5, with discovery of 3 micro-papillary thyroid carcinomas, in a single patient (complementary (131)I treatment). No thyroid carcinomas were found for the other 4 patients. No patients died from thyroid carcinoma during follow-up (mean: 41 months). The prevalence of lymph node metastasis from thyroid carcinoma in cervical lymph node dissection during treatment of HNSCC seems higher (7.9%) than rates reported in the literature (0.3 to 1.6%). This may be due to the histopathological methods employed. Management of patients should be discussed in the light of thyroid ultrasonography and prognosis of HNSCC. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center

    DEFF Research Database (Denmark)

    Rubek, Niclas; Channir, Hani Ibrahim; Charabi, Birgitte Wittenborg

    2017-01-01

    (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September...... bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N......-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may...

  2. Athermal bladder neck dissection during robot-assisted radical prostatectomy

    OpenAIRE

    Fabrizio Dal Moro

    2014-01-01

    Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN) serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at...

  3. The Indications and Clinical Curative Effects of Modified Neck Dissection in Head and Neck Cancers

    Institute of Scientific and Technical Information of China (English)

    GuohaoWu; WeiweiUu; FujinChen; ZongyuanZeng; HaoLi; MingSong; MaowenWei; QuanZhang; AnkuiYang; WenkuanChen

    2004-01-01

    OBJECTIVE Functional neck dissection was first described by Bocca and Pignataro in 1967. It has been used in clinical practice for years, but remains controversial among neck-surgery experts. This study was designed to evaluate indications and curative effects of functional-neck dissection (FND). METHODS One hundred and fifty-two cases which underwent FND were reviewed with an analysis of pathological specimens and follow-up datas. RESULTS The series of FND included 20 cases of tongue carcinoma, 23 cases of larynx carcinoma, 96 cases of thyroid papillary adenocarcinoma, 9 cases of follicular adenocarcinoma and 4 cases of medullary adenocarcinoma; the five-year recurrence rate for tongue carcinoma was 12.5%, 14.3%, 40.0% and for a larynx carcinoma was 20.0%, 16.7%, 50.0% in N0 stage, N1 stage, N2a stage, respectively. The 5-year recurrence rate of thyroid papillary adenocarcinoma was 6.5%, 7.1% in N1a, N1b, respectively. CONCLUSION Functional neck dissection is indicated in early and low malignant head and neck neoplasms and results in satisfactory curative effects.

  4. Single transverse extended incision for radical neck dissection.

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    Chagas, José Francisco Sales; Pascoal, Maria Beatriz Nogueira; Aquino, José Luís Braga; Brandi, Luís Antônio; Previtale, Evandro Von Zuben; Trillo, Ana Sofia Pontes; Curioni, Otávio Alberto; Rapoport, Abrão; Dedivitis, Rogério Aparecido

    2016-01-01

    to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio

  5. Shoulder pain and disability in daily life, following supraomohyoid neck dissection : a pilot study

    NARCIS (Netherlands)

    van Wilgen, CP; Dijkstra, PU; Nauta, JM; Vermey, A; Roodenburg, JLN

    Introduction: The purpose of this pilot study was to assess shoulder morbidity; i.e. pain and disability in daily activities, at least I year after unilateral or bilateral supraomohyoid neck dissection. Patients and methods: 52 patients having been subjected to a supraomohyoid neck dissection

  6. Shoulder pain and disability in daily life, following supraomohyoid neck dissection : a pilot study

    NARCIS (Netherlands)

    van Wilgen, CP; Dijkstra, PU; Nauta, JM; Vermey, A; Roodenburg, JLN

    2003-01-01

    Introduction: The purpose of this pilot study was to assess shoulder morbidity; i.e. pain and disability in daily activities, at least I year after unilateral or bilateral supraomohyoid neck dissection. Patients and methods: 52 patients having been subjected to a supraomohyoid neck dissection comple

  7. UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN HEAD AND NECK CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    刘宝国; 赵振生; 李明强; 陈荣鋭; 王建军; 张乃嵩

    2004-01-01

    Objective: To investigate for the feasibility and advantages performed by the unilateral big hockey stick incision (BHSI) in head and neck carcinoma. Methods: Neck dissection by using the unilateral big hockey stick incision (BHSI) was performed on 93 patients with head and neck carcinoma. Results: The big hockey stick incision has a cosmetic scar and not scar contraction and is barely visible and easily covered in hair and clothing; sufficient exposure of the operation field; a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to having preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

  8. Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer

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    Kim, Jinu; Shin, Eun Seow; Kim, Jeong Eon; Yoon, Sang Pil [Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Young Suk [Dept. of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2015-12-15

    Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.

  9. Reduced low-traumatic access thyroidectomy with central neck dissection

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    A. V. Shabunin

    2016-01-01

    Full Text Available Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC, the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 % cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale 68 (89.5 % patient was recognized as a excellent, and 8 (10.5 % as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results. 

  10. The Role of Prophylactic Central Neck Dissection in the Treatment of Differentiated Thyroid Cancer

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    Max Hennessy

    2016-01-01

    Full Text Available The utility and efficacy of prophylactic central neck dissection with total thyroidectomy for the treatment of differentiated thyroid cancer has been debated in the literature over the past few decades. Proponents of prophylactic central neck dissection support its routine use with the notion that it reduces local recurrence, increases accuracy in TNM staging, and reduces surgical morbidity associated with reoperation. Conversely, those against the use of routine prophylactic central neck dissection argue there is no clear evidence which shows a reduction in recurrence or added benefit to survival, while the procedure increases the risk for complications and morbidity. This article discusses the role of prophylactic central neck dissection in the setting of thyroid cancer and reviews recently published literature to evaluate efficacy and safety of this procedure.

  11. Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma

    OpenAIRE

    Xu, Jiajie; Chen, Chao; Zheng,ChuanMing; Wang, Kejing; Shang, Jinbiao; FANG, XIANHUA; Ge, Minghua; TAN, ZHUO

    2016-01-01

    The present study aimed to discuss the advantage of the application of a cervical low incision for functional neck dissection in patients with thyroid papillary carcinoma. The study was a retrospective analysis of 87 thyroid papillary carcinoma patients; cervical low incision in the functional neck dissection was applied for 47 cases and the classic ‘L’ incision was applied for 40 cases. The different integrity, surgical time, blood loss and the aesthetic property of the incision were compare...

  12. Morbidity after neck dissection in head and neck cancer patients : a study describing shoulder and neck complaints, and quality of life

    NARCIS (Netherlands)

    Wilgen, Cornelis Paul van

    2004-01-01

    In this thesis we are aiming at more insight in morbidity after head and neck cancer treatment (resection of the primary tumour, neck dissection and pre-or post-operative radiation therapy). We will study shoulder complaints and the role of the spinal accessory nerve, pain and the underlying pain

  13. Morbidity after neck dissection in head and neck cancer patients : a study describing shoulder and neck complaints, and quality of life

    NARCIS (Netherlands)

    Wilgen, Cornelis Paul van

    2004-01-01

    In this thesis we are aiming at more insight in morbidity after head and neck cancer treatment (resection of the primary tumour, neck dissection and pre-or post-operative radiation therapy). We will study shoulder complaints and the role of the spinal accessory nerve, pain and the underlying pain me

  14. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients.

    Science.gov (United States)

    Gambardella, Claudio; Tartaglia, Ernesto; Nunziata, Anna; Izzo, Graziella; Siciliano, Giuseppe; Cavallo, Fabio; Mauriello, Claudio; Napolitano, Salvatore; Thomas, Guglielmo; Testa, Domenico; Rossetti, Gianluca; Sanguinetti, Alessandro; Avenia, Nicola; Conzo, Giovanni

    2016-09-19

    Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. In the last years, higher papillary thyroid cancer incidence and more

  15. Vertebral artery dissection due to indirect neck trauma : an underrecognised entity.

    Directory of Open Access Journals (Sweden)

    Prabhakar S

    2001-10-01

    Full Text Available Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. Three patients of vertebral artery dissection related to indirect neck trauma are described. The first patient developed the symptoms while dancing, the second after a trivial fall and the third while he was on a dental chair. None of them had a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology was similar in all the patients and included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA territory. One of the patients also had associated ischaemic myelopathy. MRA and DSA confirmed dissection in all with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as ′spontaneous′ or ′traumatic′, there is a possible ambiguity in literature about appropriate terminology. We emphasise that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognise this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.

  16. Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers

    Science.gov (United States)

    Kito, Shinji; Koga, Hirofumi; Kodama, Masaaki; Habu, Manabu; Kokuryo, Shinya; Oda, Masafumi; Matsuo, Kou; Nishino, Takanobu; Matsumoto-Takeda, Shinobu; Uehara, Masataka; Yoshiga, Daigo; Tanaka, Tatsurou; Nishimura, Shun; Miyamoto, Ikuya; Sasaguri, Masaaki; Tominaga, Kazuhiro; Yoshioka, Izumi; Morimoto, Yasuhiro

    2016-01-01

    Background 18F-fluoro-2-deoxy-D-glucose (18F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. Material and Methods 18F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. Results According to the extent of ND of cervical lymph nodes, the rate of patients with 18F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. Conclusions In evaluating 18F-FDG accumulations after ND for oral cancers, we should pay attention to the 18F-FDG distributions in neck-related muscles including the non-surgical side as false-positive findings. Key words:18F-FDG, PET-CT, oral cancers, muscles. PMID:27031062

  17. Morbidity after neck dissection in head and neck cancer patients: a study describing shoulder and neck complaints, and quality of life

    OpenAIRE

    2004-01-01

    In this thesis we are aiming at more insight in morbidity after head and neck cancer treatment (resection of the primary tumour, neck dissection and pre-or post-operative radiation therapy). We will study shoulder complaints and the role of the spinal accessory nerve, pain and the underlying pain mechanisms, range of motion, and loss of sensation. The consequences of dysfunction such as shoulder disability and activities of daily living, but also psychological problems (depression) and qualit...

  18. Lateral lower face and neck contouring following burn injury.

    Directory of Open Access Journals (Sweden)

    Sadrollah Motamed

    2015-04-01

    Full Text Available The neck is normally a concave and highly mobile structure. Facial and cervical skin is prone to burn scar contracture because of its thin nature. The goal of treatment is to reconstruct this region to achieve a good aesthetic outcome and also normal neck and chin mobilization. This study was conducted to compare the effect of one row of suture and three rows of suture in critical points of the neck to recreate cervicomandibular angle for better contouring of the neck. A cross-sectional study was performed from July 2006 until August 2010. A total of 65 patients underwent lower lateral face and neck burn scar contracture reconstruction. The mean age of participants was 25.5 years old. After designing a local flap, in 31 patients we applied one row of suture. In 34 patients, we used three rows of suture on each side of the neck incorporation with  the recipient bed and the flap dermis or capsule to recreate a natural lower lateral face and neck contour (P<0.001. The standard deviation in hospitalization was 7 ± 2 days for group A and 6 ± 1 days for group B. In a two years follow-up, no blunting of cervicomandibular angle occurred and three rows of suture were superior according to present findings.

  19. Modified minimally invasive video-assisted lateral neck dissection for papillary thyroid carcinoma: a series of 130 cases%改良Miccoli手术颈侧区淋巴结清扫术治疗甲状腺乳头状癌130例临床分析

    Institute of Scientific and Technical Information of China (English)

    章德广; 高力; 谢磊; 何高飞; 方亮; 陈剑; 苗滪汶; 王喆喆

    2016-01-01

    Objective To discuss the feasibility,safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection (MIVALND) for papillary thyroid carcinoma.Methods Data of 130 patients from Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Medical School,Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively.There were 31 male and 99 female patients with the mean age of (39± 11) years.The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted (VA) approach,lateral neck dissection was performed via the VA approach.Serum thyroglobulin and thyroglobulin antibody levels were measured every 6 months after surgery.Ulrasonography was performed to assess the thyroid bed and lateral neck compartment every 6 months after surgery.The mean operation time for MIVALND,mean postoperative hospital stay,size of primary tumor,number of retrieved lymph nodes,complication rates,and postoperative serum thyroglobulin levels were analyzed retrospectively.The patients were followed up by outpatient review and until March 2016.Results Beside 1 case was converted to open procedure,129 (99.2%) patients successfully underwent MIVALND.The mean operative time was (74±17) min (ranging from 40 to 120 rin) for MIVALND.The mean postoperative hospital stay was (4.9±2.1) days (range 2 to 14 days).The mean size of primary tumor was (1.3±0.7) cm (range 0.3 to 4.0 cm).The mean number of lymph nodes removed was 42± 13 (range 15 to 79) in lateral compartment.Postoperative complications included 19 transient hypoparathyroidism,7 transient recurrent laryngeal nerve (RLN) palsy and 3 permanent RLN palsy (tumor invasion and the RLN was resected en bloc with the tumor in 2 cases),2 (1.5%) transient palsy of spinal accessory nerve,1 (0.8%) transient palsy of marginal mandibular branch of the facial nerve,1 (0.8%) seroma,and 4 (3.1%) minor chyle leak

  20. Measurement of the trapezius muscle volume: A new assessment strategy of shoulder dysfunction after neck dissection for the treatment of head and neck cancers.

    Science.gov (United States)

    Cho, Jae-Gu; Lee, Naree; Park, Min-Woo; Baek, Seung-Kuk; Kwon, Soon-Young; Jung, Kwang-Yoon; Woo, Jeong-Soo

    2015-05-01

    The purpose of this study was to determine the actual degree of shoulder muscle change and its relation to symptoms after neck dissection for head and neck cancers. Forty-two patients who underwent unilateral neck dissection were selected. Data obtained from each subject were trapezius muscle volume ratio and a Shoulder Disability Questionnaire (SDQ) score. Patients who had undergone neck dissection with spinal accessory nerve (SAN) preservation were compared with those who had received radical neck dissection. The preservation group was further separated into subgroups by the extent of neck dissection. Trapezius muscle volume ratio was higher and SDQ score was significantly lower in the SAN preservation group compared to the radical neck dissection group. However, the SAN preservation subgroups did not differ from each other. In addition, a good correlation between the muscle volume ratio and SDQ score was observed. With trapezius muscle volume ratio, clinicians may be able to diagnose shoulder dysfunction after neck dissection. Further research on the subject is warranted. This suggests a novel strategy for assessing the degree of shoulder dysfunction. © 2014 Wiley Periodicals, Inc.

  1. TRAPEZOID SHAPED OMOHYOIDEUS MUSCLE: An Anatomic Variation seen in Functional Neck Dissection

    OpenAIRE

    Lokman Uzun; Numan Kokten; Gul Ozbilen Acar

    2015-01-01

    Omohyoid muscle (Om) is an important anatomical landmark in cervical lymph node partition, neck dissection for head and neck cancers and cervical spine surgery. It consists of two bellies united at an angle by an intermediate tendon. Variations in the origin and insertion of the muscle, absence or duplication of the superior or inferior bellies, aberrant position in relation to IJV and sternocleideomastoid muscle have been reported. We report a rare anatomical variation of the Om in this repo...

  2. Elective neck dissection in oral carcinoma: a critical review of the evidence.

    Science.gov (United States)

    Kowalski, L P; Sanabria, A

    2007-06-01

    More than 50% of patients with squamous cell carcinoma of the oral cavity have lymph node metastases and histological confirmation of metastatic disease is the most important prognostic factor. Among patients with a clinically negative neck, the incidence of occult metastases varies with the site, size and thickness of the primary tumour. The high incidence rate of occult cervical metastases (> 20%) in tumours of the lower part of the oral cavity is the main argument in favour of elective treatment of the neck. The usual treatment of patients with clinically palpable metastatic lymph nodes has been radical neck dissection. This classical surgical procedure involves not only resection of level I to V lymph nodes of the neck but also the tail of the parotid, submandibular gland, sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve. It is a safe oncological surgical procedure that significantly reduces the risk of regional recurrences, however it produces significant post-operative morbidity, mainly shoulder dysfunction. Aiming to reduce morbidity, Ward and Roben described a modification of the procedure sparing the spinal accessory nerve to prevent post-operative shoulder morbidity. Several clinical and pathological studies have demonstrated that the pattern of metastatic lymph node metastases occurs in a predictable fashion in patients with oral and oropharyngeal carcinoma. The use of selective supraomohyoid neck dissection as the elective treatment of the neck, in oral cancer patients, is now well established. However, its role in the treatment of clinically positive neck patients is controversial. Some Authors advocate this type of selective neck dissection in patients with limited neck disease at the upper levels of the neck, without jeopardizing neck control. The main factors supporting this approach are the usually good prognosis in patients with single levels I or II metastasis independent of the extent of neck dissection, and the low

  3. Shoulder complaints after neck dissection; is the spinal accessory nerve involved?

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    The purpose of the current study was to investigate the relation between shoulder morbidity (pain and range of motion), and the function of the spinal accessory nerve after neck dissection. Identifying dysfunction of the nerve gives insight in the mechanisms of post-operative shoulder complaints. In

  4. Impact of middle and lower jugular neck dissection on supraclavicular lymph node metastasis from endometrial carcinoma

    Science.gov (United States)

    2012-01-01

    Supraclavicular lymph node metastasis from endometrial carcinoma is considerably rarer than metastasis from uterine cervical cancer. To date, there have been no reported cases regarding systematic neck dissection as a salvage treatment. In this report, we describe the neck dissection procedure carried out on a 74-year-old woman with supraclavicular lymph node metastasis. Our objective was to histologically determine the origin of the metastasis while simultaneously providing appropriate treatment. The patient’s past medical history included two prior cases of cancer: rectal cancer 7 years earlier and endometrial adenocarcinoma 4 years earlier. We determined that middle and lower jugular neck dissection was appropriate in treating this case based on the results of our preoperative FDG-PET and tumor markers. This surgery provided histological evidence that metastasis occurred from endometrial carcinoma. Middle and lower jugular neck dissection was expected to improve the patient’s prognosis without impacting the patient’s active daily life. We have continued to monitor the patient closely over an extended period. PMID:22788987

  5. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN

    2001-01-01

    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a n

  6. Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

    NARCIS (Netherlands)

    Stuiver, Martijn M.; van Wilgen, Cornelis P.; de Boer, Erlijn M.; de Goede, Cees J. T.; Koolstra, Muriel; van Opzeeland, Anita; Venema, Piet; Sterken, Margriet W.; Vincent, Andrew; Dijkstra, Pieter U.

    2008-01-01

    OBJECTIVE: To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. STUDY DESIGN: Prospective. PATIENTS AND METHODS: Shoulder pain, shoulder mobility, and shoulder droo

  7. POSTEROLATERAL NECK DISSECTION IN PATIENTS WITH MELANOMA OF THE SKIN OF THE POSTERIOR SCALP

    NARCIS (Netherlands)

    VERMEY, A; PLUKKER, JTM; ROODENBURG, JLN; OLDHOFF, J

    1993-01-01

    19 consecutive patients underwent a posterolateral neck dissection (PLND) in continuity with a wide excision of the primary melanoma on the posterior scalp. After a mean follow-up of 74 months, 5 patients are alive with minimal morbidity. PLND can safely be performed, even bilaterally, as an

  8. [Aortic valve replacement as an independent predictive factor for later development of aortic dissection].

    Science.gov (United States)

    von Kodolitsch, Y; Simic, O; Bregenzer, T; Dresler, C; Haverich, A; Nienaber, C A

    1998-08-01

    Dissection of the ascending aorta (type A) following later after aortic valve replacement has been described with increasing frequency. This study analyzes the role of aortic valve replacement for the evolution of late dissection. In a series of 80 consecutive patients with type A dissection, a previous aortic valve replacement had been performed in 12 cases (15%). In addition to arterial hypertension (p syndrome (p factor for type A dissection. Dissection occurred 3 +/- 4 years after aortic valve replacement with a clinical and anatomical profile similar to classic dissection as proven by comparison to a group of 62 patients with classic dissection associated with arterial hypertension or Marfan syndrome. With 75% and 66%, respectively, 30 day and 1 year survival of patients with dissection following later after aortic valve replacement was similar to patients with classic type A dissection. Extensive thinning and/or fragility (p associated with a high risk for late dissection; this finding was substantiated by comparison to a control group of 10 consecutive patients with a similarly dilated aortic root but no dissection. Type and diameter of valve prostheses, cross-clamp time, NYHA functional class, and left ventricular ejection fraction were unrelated to late dissection. Previous aortic valve replacement is an independent predisposing factor for a dissection of the ascending aorta later. At the time of aortic valve replacement, prophylactic replacement or wrapping of the ascending aorta should be considered in patients with a thinned/fragile aortic wall even without a markedly dilated aortic root.

  9. Vertebral artery dissection with compelling evidence on duplex ultrasound presenting only with neck pain

    Directory of Open Access Journals (Sweden)

    Siepmann T

    2016-11-01

    Full Text Available Timo Siepmann, Monique Borchert, Kristian Barlinn Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany Abstract: Vertebral artery dissection (VAD is among the most common identifiable etiologies of stroke in young adults and poses a diagnostic challenge due to nonspecific symptoms and substantial variability of imaging results. Here, we present a case of unspecific neck pain as isolated symptom of VAD with unusually compelling evidence on duplex ultrasound. This observation has clinical relevance as the absence of any neurological symptoms in our patient highlights the necessity of considering cervical artery dissection in patients presenting with unspecific symptoms such as neck pain, even if isolated. Furthermore, our image of intramural hematoma on duplex ultrasound has been captured in an unusual, clear and distinct fashion and might therefore be a useful reference image in the clinical assessment of patients with a suspicion of cervical artery dissection. Keywords: vertebrobasilar, cervical, duplex sonography, magnetic resonance imaging

  10. Vertebral artery dissection with compelling evidence on duplex ultrasound presenting only with neck pain

    Science.gov (United States)

    Siepmann, Timo; Borchert, Monique; Barlinn, Kristian

    2016-01-01

    Vertebral artery dissection (VAD) is among the most common identifiable etiologies of stroke in young adults and poses a diagnostic challenge due to nonspecific symptoms and substantial variability of imaging results. Here, we present a case of unspecific neck pain as isolated symptom of VAD with unusually compelling evidence on duplex ultrasound. This observation has clinical relevance as the absence of any neurological symptoms in our patient highlights the necessity of considering cervical artery dissection in patients presenting with unspecific symptoms such as neck pain, even if isolated. Furthermore, our image of intramural hematoma on duplex ultrasound has been captured in an unusual, clear and distinct fashion and might therefore be a useful reference image in the clinical assessment of patients with a suspicion of cervical artery dissection. PMID:27843318

  11. TRAPEZOID SHAPED OMOHYOIDEUS MUSCLE: An Anatomic Variation seen in Functional Neck Dissection

    Directory of Open Access Journals (Sweden)

    Lokman Uzun

    2015-12-01

    Full Text Available Omohyoid muscle (Om is an important anatomical landmark in cervical lymph node partition, neck dissection for head and neck cancers and cervical spine surgery. It consists of two bellies united at an angle by an intermediate tendon. Variations in the origin and insertion of the muscle, absence or duplication of the superior or inferior bellies, aberrant position in relation to IJV and sternocleideomastoid muscle have been reported. We report a rare anatomical variation of the Om in this report. This variation was observed during neck dissection of a 58 years-old male patient with laryngeal carcinoma. It was noticed that, the superior belly of Om was in a trapezoid shaped unilaterally.

  12. Evaluation of shoulder disability questionnaires used for the assessment of shoulder disability after neck dissection for head and neck cancer.

    Science.gov (United States)

    Goldstein, David P; Ringash, Jolie; Bissada, Eric; Jaquet, Yves; Irish, Jonathan; Chepeha, Douglas; Davis, Aileen M

    2014-10-01

    Several questionnaires have been used to evaluate shoulder disability after neck dissection. The purpose of this study was to review these measures and highlight their strengths and weaknesses. A literature review was performed to identify measures of shoulder disability after head and neck cancer surgery. These measures were evaluated in terms of their methods of development and assessment of their psychometric properties. Seven questionnaires were identified. Several of the other questionnaires have been well developed but have not had their psychometric properties assessed in the head and neck cancer population. Each questionnaire has its strengths and weaknesses. The strengths and weaknesses of the shoulder disability questionnaires should be considered when deciding which questionnaire to use. Efforts should be focused on using well-designed questionnaires that have been assessed in this patient population rather than developing or using other questionnaires. © 2013 Wiley Periodicals, Inc.

  13. Elective neck dissection in oral squamous cell carcinoma of the upper maxilla:necessary?

    Institute of Scientific and Technical Information of China (English)

    Manuel Moreno-Sánchez

    2016-01-01

    Aim: Surgical treatment of clinically negative neck in maxillary squamous cell carcinoma (SCC) of the upper jaw is controversial. The purpose of this systematic review was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected.Methods: An electronic literature search was conducted in several databases, including MEDLINE, EMBASE, and Cochrane Central databases, for articles written in English. Results: Twenty-eight articles were included in the review. The overall cervical metastases rate was 33% and the total initial cervical metastases rate was 16%. Interestingly, the author found that 71% of patients with cervical metastases from maxillary SCC carcinoma were T3/T4 stage. Conclusion:This review shows the need for a change in the management of the N0 neck in SCC arising in the maxillary alveolus and hard palate. Elective neck dissection should be performed in patients with T3/T4 tumours with clinic or radiographic negative necks (N0c).

  14. Feasibility of robot-assisted modified radical neck dissection by post-auricular facelift approach.

    Science.gov (United States)

    Tae, K; Ji, Y B; Song, C M; Sung, E S; Chung, J H; Lee, S H; Park, H J

    2016-11-01

    The aim of this study was to evaluate the technical feasibility and safety of robot-assisted modified radical neck dissection (MRND) for head and neck cancer patients with a clinically node-positive neck. The cases of 10 head and neck cancer patients who underwent unilateral therapeutic robot-assisted MRND by post-auricular facelift approach were analyzed. The robot-assisted MRND was completed successfully in all patients without any conversion to conventional neck dissection. The mean number of lymph nodes removed was 36.7±8.6. The mean duration of surgery for robot-assisted MRND was 274±65min (range 175-395min). Transient marginal nerve palsy occurred in two patients and partial necrosis of the skin flap occurred in one patient. In terms of cosmetic satisfaction, 70% of patients were very satisfied or satisfied with postoperative cosmesis. In conclusion, robot-assisted MRND by post-auricular facelift approach is technically feasible and safe in selected patients with head and neck cancer, and yields excellent postoperative cosmesis. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? Yes.

    Science.gov (United States)

    Paulus, Jessica K; Thaler, David E

    2016-01-01

    For patients and health care providers who are considering spinal manipulative therapy of the neck, it is crucial to establish if it is a trigger for cervical artery dissection and/or stroke, and if it is, the magnitude of the risk. We discuss the biological plausibility of how neck manipulation could cause cervical artery dissection. We also discuss how case misclassification threatens the validity of influential published studies that have investigated the relationship between neck manipulation and dissection. Our position is supported by the fact that the largest epidemiologic studies of neck manipulation safety with respect to neurological outcomes have relied on International Classification of Diseases-9 codes for case identification. However, the application of these codes in prior studies failed to identify dissections (rather than strokes in general) and so conclusions from those studies are invalid. There are several methodological challenges to understanding the association between neck manipulation and vertebral artery dissection. Addressing these issues is critical because even a modest association between neck manipulation and cervical artery dissection could translate into a significant number of avoidable dissections given the widespread use of neck manipulation by providers from various backgrounds. We believe that valid case classification, accurate measurement of manipulative procedures, and addressing reverse causation bias should be top priorities for future research.

  16. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer

    Science.gov (United States)

    Costa, S; Giugliano, G; Santoro, L; Ywata De Carvalho, A; Massaro, MA; Gibelli, B; De Fiori, E; Grosso, E; Ansarin, M; Calabrese, L

    2009-01-01

    Summary Prophylactic central neck dissection in papillary thyroid cancer is controversial. In this retrospective cohort study, the aim was to assess possible advantages of prophylactic central neck dissection with total thyroidectomy in cN0 papillary thyroid cancer. A total of 244 consecutive patients with papillary thyroid cancer, without clinical and ultrasound nodal metastases (cN0), were evaluated out of 1373 patients operated for a thyroid disease at the Istituto Europeo di Oncologia, Milan, Italy from 1994 to 2006. Of these 244 patients, 126 (Group A) underwent thyroidectomy with central neck dissection, while 118 (Group B) underwent thyroidectomy alone. Demographic, clinical and pathological features were analysed. Overall recurrence rate was 6.3% (8/126) in Group A and 7.7% (9/118) in Group B, with a mean follow-up of 47 (Group A) and 64 (Group B) months. In Group A patients, 47% were pN1a and all patients with recurrence had nodal involvement (p = 0.002). Survival rate did not differ in the two groups. Nine patients were lost to follow-up. Group A patients were older and their tumours were larger in size; according to the pT distribution, a higher extra-capsular invasion rate was observed. The two groups were equivalent as far as concerns histological high risk variants and multifocality. Nodal metastases correlated with stage: pT1-2 vs. pT3-T4a, p = 0.0036. A lower risk of nodal metastases was related to thyroiditis (p = 0.0034). In conclusion, central neck metastases were predictive of recurrence without influencing prognosis. From data obtained, possible greatest efficacy of central neck dissection in pT3-4 papillary thyroid cancer without thyroiditis is suggested. PMID:20111614

  17. Contralateral neck dissection in oral squamous cell carcinoma:when it should be done?

    Institute of Scientific and Technical Information of China (English)

    Laura Villanueva-Alcojol

    2016-01-01

    Oral cavity squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes bilaterally because of the rich lymphatics in the submucosal plexus, which freely communicate across the midline. The presence of contralateral pathologic lymph nodes has been reported previously as a critical factor influencing the survival of patients. There are a few reports in the literature with regard to the rates of contralateral neck disease and the factors that may be involved in the risk with them. An elective ipsilateral neck treatment is generally recommended for initial treatment in all OSCC. However, no consensus exists whether or not to perform an elective contralateral neck dissection or radiation. In this study, a systematic review has been performed in order to evaluate the predictive value of clinical-histopathologic factors potentially related to contralateral occult lymph node metastasis in squamous cell carcinomas of the oral cavity to form a rational basis for elective contralateral neck management.

  18. Practice patterns among thyroid cancer surgeons: implications of performing a prophylactic central neck dissection

    OpenAIRE

    Deutschmann, Michael W.; Chin-Lenn, Laura; Nakoneshny, Steven C.; Dort, Joseph C.; Pasieka, Janice L.; Chandarana, Shamir P.

    2016-01-01

    Background Indications for performing a prophylactic central neck dissection (pCND) in papillary thyroid cancer (PTC) remain controversial. It is unclear how identification of lymph node (LN) metastases should impact the decision to treat with radioactive iodine (RAI). The goals of this study were to identify indications for performing pCND and identify factors that predict the use of adjuvant RAI. Methods This was a population based cross-sectional analysis. A prospectively collected databas...

  19. Is Routine Central Neck Dissection Necessary for the Treatment of Papillary Thyroid Microcarcinoma?

    OpenAIRE

    Choi, Se Jun; Kim, Tae Yong; Lee, Jong Cheol; Shong, Young Kee; Cho, Kyoung-Ja; Ryu, Jin Sook; Lee, Jeong Hyun; Roh, Jong-Lyel; Kim, Sang Yoon

    2008-01-01

    Objectives It remains unclear as to whether routine central neck dissection (CND) is necessary when performing surgery to treat patients with papillary thyroid microcarcinoma (PTMC). To determine the necessity for routine CND in PTMC patients, we reviewed the clinicopathologic and laboratory data of the patients of PTMC. Methods Between September 2001 and July 2005, 101 patients with PTMC and clinical N0 disease were retrospectively reviewed. The study cohort was devided into groups: the tota...

  20. Can neck irradiation be an alternative to neck dissection in early stage carcinoma oral tongue operated for primary alone? Experience from a single institute

    Directory of Open Access Journals (Sweden)

    Sushmita Ghoshal

    2016-07-01

    Full Text Available Purpose: To study pattern of failure, locoregional control rates (LCR and disease free survival (DFS in post-operative patients of carcinoma oral tongue, and to study the impact of nodal dissection on DFS in stage I and II patients.Methods: 102 patients of carcinoma oral tongue treated between January 2009 and December 2013 were analyzed. All patients were operated for primary disease, but neck dissection was done in 78 (76.5% patients only. However, radiation to primary site along with neck region was received by all patients. Pattern of failure, LCR and DFS were estimated.Results: At median follow up of 12 months, 10.8% patients failed locally, 10.8% in nodal region, 2.9% both at local and nodal site, and 5.9% patients failed distally. 2 year LCR and DFS was 71.2%, 90.9%, 79.5%, 0% and 55.2%, 64.4%, 57.8%, 0% in stage I, II, III, IV respectively. 2 year DFS in stage I patients, who underwent nodal dissection and post-operative radiation (14 patients was 64.3% and in whom only neck irradiation was done (15 patients, it was 45.8%, however difference was not significant (p = 0.5. But in stage II patients, 33 patients who underwent nodal dissection and post-operative radiation, 2 year DFS was 85.4% and it was 21.4% in 7 patients who underwent neck radiation only, and difference showed trend towards significance (p = 0.05. 2 or more positive lymph nodes post dissection was the only poor prognostic factor that correlated with DFS (p = 0.02Conclusion: While in stage I, neck irradiation alone can be a possible alternative to neck dissection and post-operative radiation; for stage II, neck dissection is mandatory.

  1. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Henry Y. Lin

    2015-03-01

    Conclusion: Improved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

  2. The Use of Harmonic Scalpel for Free Flap Dissection in Head and Neck Reconstructive Surgery

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    Sebastien Albert

    2012-01-01

    Full Text Available Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group, and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group. The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group, blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps.

  3. The use of harmonic scalpel for free flap dissection in head and neck reconstructive surgery.

    Science.gov (United States)

    Albert, Sebastien; Guedon, Charles; Halimi, Caroline; Cristofari, Jean Pierre; Barry, Beatrix

    2012-01-01

    Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps.

  4. Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral Neck dissection in squamous cell carcinoma of the larynx: indication of elective contralateral neck dissection

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    Ali Amar

    2012-04-01

    , considering the anatomical sub-sites and the midline. RESULTS: Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. CONCLUSION: In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors.

  5. Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.

    Science.gov (United States)

    Grishkevich, Viktor M; Grishkevich, Max

    2015-01-01

    Lateral contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical contractures were divided into two types based on their anatomy: edge and medial. Edge contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the contracture. Medial contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (contracture cause). In all cases, there was surface surplus in the fold's sheets allowed contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.

  6. Effectiveness of the supraomohyoid neck dissection in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus.

    Science.gov (United States)

    Rahamthulla, S A K Uroof; Priya, P Vani; Hussain, S M D Javeed; Nasyam, Fazil Arshad; Akifuddin, Syed; Srinivas, Velpula Sasidhar

    2015-01-01

    To evaluate the effectiveness of the supraomohyoid neck dissection in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus. This was a prospective study of five patients with squamous cell carcinoma of gingivobuccal mucosa of oral cavity with clinically N0 neck, conducted over a period of 2 years from July 2007 to Oct 2009 in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital. The study was conducted in patients irrespective of age, sex, size, thickness, and type of differentiation of the lesion. All patients have clinically non-palpable lymphnodes (N0 neck), while patients with palpable lymphnodes, patients with previous surgery, and patients with previous radiotherapy were excluded from the study. Level I was the commonest site of neck metastasis in our study. Among the five patients, two (40%) patients (case 2 and 3) had occult cervical metastasis (level IB nodes are histopathologically positive nodes) and the remaining three patients (60%) had no occult cervical metastasis. The recurrence rate was 20% for patients who received postoperative radiotherapy. There was no morbidity and postoperative dysfunction and the mortality rate was only 20% in our study. Supraomohyoid neck dissection is the therapeutic procedure in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus of mandible. Supraomohyoid neck dissection, when indicated, contributes to the concept of less-invasive surgery and offers functional and aesthetic advantages without compromising the clearance with minimal morbidity.

  7. Conservative neck dissection in oral cancer patients: A 5 years retrospective study

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    Wan Mahadzir Wan Mustafa

    2016-06-01

    Full Text Available The impact of ablative oral cancer surgery was studied, with reference to recurrence and nodal metastasis,  survival probability and prognostic indicators and to determine if ethnicity influences the survival of patients. Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and assessed. Those with stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009 were included in this study. All individuals had a pre-operative assessment and post operative assessment. Survival distributions were analyzed using Kaplan-Meier curves. Eighty seven patients (males: 38%; females: 62% were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal and primary site recurrence was 5.7% and 20.5%. The median survival time was 57 months. One year Overall Survival (OS rate was 72.7% and three year overall survival rate 61.5%. The log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033. Recurrence-Free Survival (RFS analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. The three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001. Conservative neck effectively controls neck metastases. Ethnicity influence  survival.

  8. Conservative neck dissection in oral cancer patients: a 5 year retrospective study in Malaysia.

    Science.gov (United States)

    Balasundram, Sathesh; Mustafa, Wan Mahadzir Wan; Ip, Jolene; Adnan, Tassha Hilda; Supramaniam, Premaa

    2012-01-01

    The impact of ablative oral cancer surgery was studied, with particular reference to recurrence and nodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influences the survival of patients. Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. All individuals had a pre-operative assessment prior to the surgery. The post operative assessment period ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. 87 patients (males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5% had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the median survival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival rate dropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and the three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001). Conservative neck is effective, in conjunction with postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival of the patients, but a prospective trial is required to validate this.

  9. Surgical correction of the webbed neck: an alternative lateral approach

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    Mehri Turki, Imen

    2017-03-01

    Full Text Available Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli.Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars.Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

  10. Surgical correction of the webbed neck: an alternative lateral approach

    Science.gov (United States)

    Mehri Turki, Imen

    2017-01-01

    Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli. Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars. Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

  11. THE UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN THYROID CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    刘宝国; 刘伟; 顾晋

    2001-01-01

    To investigate the feasibility and advantages of the unilateral big hockey stick incision in thyroid carcinoma. Method: Neck dissection using the unilateral big hockey stick incision was performed on 23 patients with thyroid carcinoma. Results: The big hockey stick incision results in a cosmetic scar which is barely visible and easily covered by hair or clothing, while it provides sufficient exposure of the operation field. A small area of marginal necrosis is occasionally seen at the apex of the skin flap due to preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

  12. Transoral endoscopic thyroidectomy with central neck dissection:experimental studies on human cadavers

    Institute of Scientific and Technical Information of China (English)

    Guo Peiyi; Tang Zhiping; Ding Zihai; Chu Guoliang; Yao Huosheng; Pan Tao; Wang Huaqiao

    2014-01-01

    Background With the development of natural orifice trans-luminal endoscopic surgery,studies on transoral video-assisted thymidectomy in preclinical experiments (e.g.,human anatomy and animal trials) were progressing gradually.From 2009 to 2011,embalmed human cadavers were dissected to define the anatomical location,surgical planes,and related neural and vascular structures to create a safe transoral access to the front cervical spaces.Recently,experimental transoral endoscopic thyroidectomy was performed to verify the feasibility of this approach on 15 fresh specimens.Methods Fifteen specimens were placed in the supine position with slight neck extension.Endoscopic incision was made on the midline between the Wharton's duct papillae and two other incisions were made on mandibular first premolar buccal mucosa.Sublingual combined bilateral vestibular tunnels were created from oral cavity to the cervical region.The neck subplatysmal working space was insufflated with CO2 at 6-8 mmHg.The bilateral thyroid lobes and central lymph nodes were dissected under craniocaudal view.Results Three incisions were made in the oral cavity without any incisions on the body surfaces.The distance from the oral cavity to front neck region was the shortest.Bilateral thyroid lobes and central neck region were fully resected via transoral approach.This approach provided a craniocaudal view,in which retrosternal thyroid gland and lymph nodes were easily accessible.The recurrent laryngeal nerve could be identified safely on the inferior cornu of the thyroid cartilage.The only structure at risk was the mental nerve.Camera motion was somewhat limited by the maxillary dentition.The volume of harvested thyroid nodule through sublingual tunnel in the fifteen human cadavers was (40±15) cm3.Conclusion The transoral procedure is progressive and innovative which not only gives the best cosmetic result and minimal access trauma but also provides a craniocaudal view.

  13. Sublingual-plunging ranula as a complication of supraomohyoid neck dissection.

    Science.gov (United States)

    Dietrich, Eva-Maria; Vasilios, Banikas; Maria, Lazaridou; Styliani, Papaemmanouil; Konstantinos, Antoniades

    2011-01-01

    Ranulas are rare cystic lesions resulting from damage or rupture of one or more of the ducts of the sublingual gland, that lead to mucus extravasation or dilatation of the gland's duct. Extravasation cysts are more common than retention cysts. We present a case of a 45-year-old male with a squamous cell carcinoma of the ventral surface of the tongue that was treated with excision of the oral lesion and bilateral supraomohyoid neck dissection without supplementary radiotherapy. A left myocutaneous platysma flap was raised for defect closure. Ten months postoperatively he presented complaining of swelling of the right submandibular region. The diagnosis, based on his medical anamnesis and the CT imaging, was a sublingual-plunging ranula. It is postulated that the ranula resulted from damage to the ducts of the sublingual gland during selective neck dissection. One year postoperatively there are no signs of recurrence either of the ranula or of the cancer. We suggest that sublingual gland excision and intraoral cyst marsupialization is a logical treatment for sublingual-plunging ranulas.

  14. Clinical outcome of salvage neck dissections in head and neck cancer in relation to initial treatment, extent of surgery and patient factors

    NARCIS (Netherlands)

    van den Bovenkamp, K.; Noordhuis, M.G.; Oosting, S.F.; van der Laan, B.F.A.M.; Roodenburg, J.L.; Bijl, H.P.; Halmos, G.B.; Plaat, B.E.C.

    ObjectiveSalvage surgery has a higher complication rate compared to primary surgical treatment. We evaluated clinical outcome of salvage neck dissections in relation to initial treatment modality, extent of surgery and patient-related factors. DesignSingle institution consecutive case series.

  15. Evaluation of the efficacy of a novel radical neck dissection preserving the external jugular vein, greater auricular nerve, and deep branches of the cervical nerve

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    Li Y

    2013-04-01

    Full Text Available Yadong Li, Jinsong Zhang, Kai Yang Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China Background: Conventional radical neck dissection often causes a variety of complications. Although the dissection method has been improved by retaining some tissues to reduce complications, the incomplete dissection may cause recurrence of disease. In the present study, we developed a novel radical neck dissection, which preserves the external jugular vein, the greater auricular nerve, and the deep branches of the cervical nerve, to effectively reduce complications and subsequently, to promote the postoperative survival quality. Methods: A total of 100 cases of radical neck dissection were retrospectively analyzed to evaluate the efficacy, rate of complication, and postoperative dysfunction of patients treated with the novel radical neck dissection. Data analysis was performed using the Chi-square test. Results: Compared with conventional radical neck dissection, the novel radical neck dissection could significantly reduce complications and promote postoperative survival quality. Particularly, the preservation of the external jugular vein reduced the surgical risk (ie, intracranial hypertension and complications (eg, facial edema, dizziness, headache. Preservation of the deep branches of the cervical nerve and greater auricular nerve resulted in relatively ideal postoperative functions of the shoulders and ear skin sensory function (P 0.05. Conclusion: Our novel radical neck dissection procedure could effectively reduce the complications of intracranial hypertension, shoulder dysfunction, and ear sensory disturbances. It can be used as a regular surgical approach for oral carcinoma radical neck dissection. Keywords: oral cancer, head and neck cancer, squamous cell carcinoma, survival quality, neck dissection, recurrence

  16. Pair bonding and lateral neck-resting preferences in captive Caribbean flamingos (Phoenicopterus ruber).

    Science.gov (United States)

    Williams, Sarah A; Anderson, Matthew J

    2012-01-01

    When flamingos rest, they typically lay their head on their back and curve their neck to either the right or left of their body, with both individual and population-level lateral preferences for rightward neck resting when preferences are tracked over time (Anderson, Williams, & O'Brien, 2009). The present study attempted to replicate these previous neck-resting preferences, to examine how they changed over time, and to examine the possibility of a relationship between lateral neck-resting preference and pair bonding in captive Caribbean flamingos (Phoenicopterus ruber) housed at the Philadelphia Zoo (Philadelphia, PA, USA). Results successfully replicated the individual- and population-level lateral preferences for rightward neck resting, and demonstrated that these preferences were stable over time. Moreover, individual flamingos that demonstrated stronger pair bond strengths tended to differ less from their partners in terms of neck-resting preference than did those birds displaying weaker pair bond strengths, suggesting a relationship between laterality and social cohesion.

  17. Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma.

    Science.gov (United States)

    Feng, Z; Gao, Y; Niu, L X; Peng, X; Guo, C B

    2014-10-01

    The objective of this study was to compare the prognosis and complications between selective neck dissection (SND) and comprehensive neck dissection (CND) for patients with a pathologically node-positive neck in squamous cell carcinoma of the tongue and the floor of the mouth. This was a retrospective cohort study. There was no significant difference between the SND group and the CND group in 3-year neck control rate (86.2% vs. 85.9%, P=0.797) or disease-specific survival (DSS) rate (64.6% vs. 61.9%, P=0.646). Further analyses of the respective 3-year DSS rates in the SND and CND subgroups were as follows: pN1 without extracapsular spread (ECS), 67.7% vs. 72.2%, P=0.851; pN2b without ECS, 64.7% vs. 68.8%, P=0.797; and pN+ with ECS, 57.1% vs. 60.0%, P=0.939. Of note, there were significantly fewer complications in the SND group compared with the CND group (7.3% vs. 20.0%, P=0.032). Multivariate analysis showed that the modality of neck treatment, pN+ status, and microscopic ECS did not serve as independent prognostic factors. SND plus adjuvant radiotherapy is a management strategy of high efficiency and minor morbidity for selected oral cancer patients with a pN+ neck with or without microscopic ECS.

  18. Potential Prognostic Benefit of Lateral Pelvic Node Dissection for Rectal Cancer Located Below the Peritoneal Reflection

    Science.gov (United States)

    Ueno, Hideki; Mochizuki, Hidetaka; Hashiguchi, Yojiro; Ishiguro, Megumi; Miyoshi, Masayoshi; Kajiwara, Yoshiki; Sato, Taichi; Shimazaki, Hideyuki; Hase, Kazuo

    2007-01-01

    Objective: To identify the parameters related to the effective selection of patients who could receive prognostic benefit from lateral pelvic node dissection. Background: Accurate preoperative diagnosis of lateral nodal involvement (LNI) remains difficult, and the indications for lateral lymph node dissection have been controversial. Patients and Methods: A total of 244 consecutive patients who underwent potentially curative surgery with lateral dissection for advanced lower rectal cancer (1985–2000) were reviewed. Patients were stratified into groups based on various parameters, and the therapeutic value index for survival benefit was compared among groups. The therapeutic index of lateral dissection was calculated by multiplying the frequency of metastasis to the lateral area and the cancer-related 5-year survival rate of patients with metastasis to the lateral area, irrespective of metastasis to other areas (mesorectal, superior rectal artery [SRA], and inferior mesenteric artery [IMA] areas). Results: LNI was observed in 41 patients (17%); and 88% of them had nodal involvement in the region along the internal iliac/pudendal artery or in the obturator region (“vulnerable field”). The cancer-related 5-year survival rate among the patients with LNI was 42%; the therapeutic index for lateral dissection was calculated as 7.0 patients, which was much higher than that of lymphadenectomy of the SRA area (1.6 patients) and the IMA area (0.4 patients), and almost comparable to that of lymphadenectomy of the upward mesorectal area (6.9 patients). Although it was possible to select groups at high and low risk for LNI based on several parameters related to tumor aggressiveness, such as tumor differentiation in biopsy specimens, the therapeutic value index was not significantly different between these groups. Unlike these parameters, the diameter of the largest lymph node in the “vulnerable field,” which was positively correlated with the rate of LNI but irrelevant

  19. Dissection of genetic factors associated with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Leblond, Claire S; Kaneb, Hannah M; Dion, Patrick A; Rouleau, Guy A

    2014-12-01

    Amyotrophic lateral sclerosis (ALS) is a fatal late onset neurological disorder characterized by motor neuron degeneration in the primary motor cortex, brainstem and spinal cord. The majority of cases are sporadic (SALS) and only 5-10% have a family history (FALS). FALS cases show a high heritability and this has enabled the identification of several genetic triggers, of which mutations in SOD1, FUS, TARDBP and C9ORF72 are the most frequent. While such advances have contributed to our current understanding of the causes of most cases of FALS and their underlying pathophysiological consequences, they only explain a small fraction of SALS with the etiology of most SALS cases remaining unexplained. Here, we review past and current methods used for the identification of FALS and SALS associated genes and propose a risk-based classification for these. We also discuss how the growing number of whole exome/genome sequencing datasets prepared from SALS cases, and control individuals, may reveal novel insights into the genetic etiology of SALS; for instance through revealing increased mutation burden rates across genes or genomic regions that were not previously associated with ALS or through allowing the examination of a potential "oligogenic" mechanism of the disease. Finally we summarize the three most recently discovered 'high risk' genes in ALS.

  20. Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection.

    Science.gov (United States)

    Tao, Yang; Wang, Chongjie; Li, Liye; Xing, Haijun; Bai, Yun; Han, Bing; Liu, Zhiyan; Yang, Xiangshan; Zhu, Shourong

    2017-01-01

    Currently the surgical approach for papillary thyroid microcarcinoma (PTMC), particularly the range of lymph node dissection, remains controversial. The present study aims to evaluate the risk factors for central and lateral lymph node metastasis (CLNM and LLNM) for appropriate clinical decision of neck lymph node dissection in PTMC. A total of 66 cases of PTMC that underwent unilateral or bilateral lobectomy plus prophylactic cervical lymph node dissection were collected for clinicopathological evaluation, including age, gender, tumor size, subtypes, extrathyroidal invasion, multifocality, calcifications, loss of cellular polarity/cohesiveness (LOP/C) in the invasive front, CLNM and LLNM, and retrospectively analysis. Univariate analysis revealed that LOP/C was significantly associated with CLNM (P=0.001) and LLNM (P0.5 cm and multifocality were high-risk factors of LLNM (P=0.022, 0.044 and 0.005, respectively). Multivariable analysis revealed that LOP/C was significantly associated with CLNM [P=0.007, odds ratio (OR)=7.765, 95% confidence interval (CI)=1.773-33.996] and LLNM [P=0.029, OR=5.717, 95% CI=1.190-27.470]. Both multivariable analysis and χ(2) test revealed that CLNM was another important high-risk factor of LLNM (P=0.021, OR=5.444, 95% CI=1.290-22.969, χ(2)=17.867, PLOP/C and CLNM, which can be performed by intraoperative frozen section pathological examination. This must be considered discreetly in the case of patients with age 0.5 cm and multifocal lesions.

  1. Preservation of the External Jugular Vein in Bilateral Radical Neck Dissections: Technique in Two Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Rodrigo Lima Bastos da Rocha

    2015-01-01

    Full Text Available Context. The possibility of cephalic venous hypertension with the resultant facial edema and elevated cerebrospinal fluid pressure continues to challenge head and neck surgeons who perform bilateral radical neck dissections during simultaneous or staged procedures. Case Report. The staged procedure in patients who require bilateral neck dissections allows collateral venous drainage to develop, mainly through the internal and external vertebral plexuses, thereby minimizing the risks of deleterious consequences. Nevertheless, this procedure has disadvantages, such as a delay in definitive therapy, the need for a second hospitalization and anesthesia, and the risk of cutting lymphatic vessels and spreading viable cancer cells. In this paper, we discuss the rationale and feasibility of preserving the external jugular vein. Considering the limited number of similar reports in the literature, two cases in which this procedure was accomplished are described. The relevant anatomy and technique are reviewed and the patients’ outcomes are discussed. Conclusion. Preservation of the EJV during bilateral neck dissections is technically feasible, fast, and safe, with clinically and radiologically demonstrated patency.

  2. Neck dissection following chemo radiation for node positive head and neck carcinomas;Place du curage ganglionnaire apres chimioradiotherapie dans les carcinomes epidermoides des voies aerodigestives superieures avec atteinte ganglionnaire initiale (nasopharynx exclu)

    Energy Technology Data Exchange (ETDEWEB)

    Thariat, J. [Centre de lutte contre le cancer Antoine-Lacassagne, Dept. de Radiotherapie, Oncologie, 06 - Nice (France); IBDC CNRS UMR 6543, 06 - Nice (France); Thariat, J.; Marcy, P.Y.; Bozec, A.; Peyrade, F.; Hofman, P. [Universite de Nice-Sophia-Antipolis, 06 - Nice (France); Hamoir, M. [Cliniques universitaires Saint-Luc, UCL, Dept. de chirurgie ORL, Bruxelles (Belgium); Janot, F. [Institut Gustave-Roussy, Dept. de chirurgie ORL, 94 -Villejuif (France); De Mones, E. [CHU de Bordeaux, Dept. de chirurgie ORL, 33 - Bordeaux (France); Marcy, P.Y. [Centre de lutte contre le cancer Antoine-Lacassagne, Dept. de Radiologie, 06 - Nice (France); Carrier, P. [CHU de Nice, Dept. de Medecine Nucleaire, 06 - Nice (France); Bozec, I. [Centre de lutte contre le cancer Antoine-Lacassagne, Dept. chirurgie ORL, 06 - Nice (France); Guevara, J.; Santini, J. [CHU Pasteur, Dept. de chirurgie ORL, 06 - Nice (France); Albert, S. [CHU Bichat, Dept. de chirurgie ORL, 75 - Paris (France); Vedrine, P.O. [CHG Cannes, 06 (France); Graff, P. [Centre de Lutte Contre le Cancer Alexis-Vautrin, Dept. de chirurgie ORL, 54 - Nancy (France); Peyrade, F. [Centre de lutte contre le cancer Antoine-Lacassagne, Dept. d' Oncologie Medicale, 06 - Nice (France); Hofman, P. [CHU de Nice, Dept. de Pathologie clinique et experimentale, 06 - (France); Centre de lutte contre le cancer Antoine-Lacassagne, CHU et tumorotheque CHU-CLCC, 06 - Nice (France); Bourhis, J. [Institut Gustave-Roussy, Dept. de Radiotherapie-oncologie, 94 - Villejuif (France); Lapeyre, M. [Centre de lutte contre le cancer Jean-Perrin, Dept. de Radiotherapie-oncologie, 63 - Clermont-Ferrand (France)

    2009-12-15

    The optimal timing and extent of neck dissection in the context of chemo radiation for head and neck cancer remains controversial. For some institutions, it is uncertain whether neck dissection should still be performed up front especially for cystic nodes. For others, neck dissection can be performed after chemo radiation and can be omitted for N1 disease as long as a complete response to chemo radiation is obtained. The question is debated for N2 and N3 disease even after a complete response as the correlation between radiological and clinical assessment and pathology may not be reliable. Response rates are greater than or equal to 60% and isolated neck failures are less than or equal to 10% with current chemo radiation protocols. Some therefore consider that systematic up front or planned neck dissection would lead to greater than or equal to 50% unnecessary neck dissections for N2-N3 disease. Positron-emission tomography (PET) scanning to assess treatment response and have shown a very high negative predictive value of greater than or equal to 95% when using a standard uptake value of 3 for patients with a negative PET at four months after the completion of therapy. These data may support the practice of observing PET-negative necks. More evidence-based data are awaited to assess the need for neck dissection on PET. Selective neck dissection based on radiological assessment and preoperative findings and not exclusively on initial nodal stage may help to limit morbidity and to improve the quality of life without increasing the risk of neck failure. Adjuvant regional radiation boosts might be discussed on an individual basis for aggressive residual nodal disease with extra-capsular spread and uncertain margins but evidence is missing. Medical treatments aiming at reducing the metastatic risk especially for N3 disease are to be evaluated

  3. Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

    Institute of Scientific and Technical Information of China (English)

    Gustavo Kishimoto; Yutaka Saito; Hajime Takisawa; Haruhisa Suzuki; Taku Sakamoto; Takeshi Nakajima; Takahisa Matsuda

    2012-01-01

    Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.

  4. A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Hideaki; Bando; Hiroaki; Ikematsu; Kuang-I; Fu; Yasuhiro; Oono; Takashi; Kojima; Keiko; Minashi; Tomonori; Yano; Takahisa; Matsuda; Yutaka; Saito; Kazuhiro; Kaneko; Atsushi; Ohtsu

    2010-01-01

    Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the co...

  5. [Evaluation of neck lymph node dissection and extended lymphadenectomy through a collar incision and median sternotomy for lung cancer].

    Science.gov (United States)

    Miyamoto, H; Hata, E; Sakao, Y; Harada, R; Hamada, T

    1995-11-01

    Since 1983, 421 patients have been treated for lung cancer at this institute. Since 1988, neck lymph node dissection (11 cases) and new extended lymphadenectomy through a collar incision and median sternotomy (22 cases) have been conducted. Indications for this new radical operation are scalene, supraclavicular or highest mediastinal node involvement, or superior pulmonary sulcus carcinoma, in patients aged 70 or less without distant metastasis and NSCLC. No major complications and operative mortality were encountered in this study. Patients with scalene or supraclavicular node involvement showed poor prognosis. Postsurgical local recurrence was frequent. Whether resection in N3 disease should be conducted or not, remains a point of controversy. The authors consider that lymphadenectomy should be conducted more extensively. A significant better survival of N2 disease and satisfactory prognosis of patients without metastasis of cervical lymph nodes demonstrates the effectiveness of neck lymph node dissection in the present superradical operation for lung cancer.

  6. Einfluss der prophylaktischen Gabe von Faktor XIII auf die Wundheilung nach Neck Dissection bei Patienten mit chronischem Alkoholkonsum

    OpenAIRE

    Asmussen, Marie

    2016-01-01

    Wound healing disorders are a common complication in patients with Alcohol Use Disorder (AUD) after neck dissection. They can be differentiated into haematomas, seromas, wound dehiscences and wound infections. Important for wound healing are blood coagulation, an adequate immune response and tissue reformation. Factor XIII (FXIII) stabilises fibrin as well as collagene and supports fibroblasts and angiogenesis amongst others. Patients with AUD probably have a reduced level of FXlll. In thi...

  7. The Benefits and Risks of Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma: Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Doh Young Lee

    2015-01-01

    Full Text Available Objectives. This study evaluated the benefits of performing prophylactic central neck dissection (CND with total thyroidectomy (TT in management of papillary thyroid carcinoma (PTC patients who were clinically node-negative at presentation. Methods. A total of 257 patients with stage T1 or T2 PTC and without preoperative evidence of lymph node involvement (N0 were enrolled in this prospective study. The patients were randomly assigned to two groups: (1 a total thyroidectomy (TT group (n=104 or (2 a TT plus CND group (n=153. The two groups were compared for their perioperative data, complication rates, disease recurrence rates, and clinical outcomes. Results. The two groups of patients were similar in age, sex ratio, follow-up duration, and tumor size (P=0.227, 0.359, 0.214, and 0.878, resp.. The two groups showed similar rates of disease recurrence (3.9% in the TT group versus 3.3% in the TT plus CND group; however, complications occurred more frequently in the TT plus CND group; especially transient hypocalcemia (P=0.043. Conclusions. Patients treated with TT plus CND had a higher rate of complications with similar recurrence rate. We believe that CND may not be routinely recommended when treating patients with PTC.

  8. The Benefits and Risks of Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma: Prospective Cohort Study.

    Science.gov (United States)

    Lee, Doh Young; Oh, Kyoung Ho; Cho, Jae-Gu; Kwon, Soon-Young; Woo, Jeong-Soo; Baek, Seung-Kuk; Jung, Kwang-Yoon

    2015-01-01

    Objectives. This study evaluated the benefits of performing prophylactic central neck dissection (CND) with total thyroidectomy (TT) in management of papillary thyroid carcinoma (PTC) patients who were clinically node-negative at presentation. Methods. A total of 257 patients with stage T1 or T2 PTC and without preoperative evidence of lymph node involvement (N0) were enrolled in this prospective study. The patients were randomly assigned to two groups: (1) a total thyroidectomy (TT) group (n = 104) or (2) a TT plus CND group (n = 153). The two groups were compared for their perioperative data, complication rates, disease recurrence rates, and clinical outcomes. Results. The two groups of patients were similar in age, sex ratio, follow-up duration, and tumor size (P = 0.227, 0.359, 0.214, and 0.878, resp.). The two groups showed similar rates of disease recurrence (3.9% in the TT group versus 3.3% in the TT plus CND group); however, complications occurred more frequently in the TT plus CND group; especially transient hypocalcemia (P = 0.043). Conclusions. Patients treated with TT plus CND had a higher rate of complications with similar recurrence rate. We believe that CND may not be routinely recommended when treating patients with PTC.

  9. Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray.

    LENUS (Irish Health Repository)

    Uzomefuna, Vincent

    2012-02-01

    Retropharyngeal abscesses (RPA) are uncommon but potentially lethal deep neck space infections, over 95% of which occur in children under six years of age. Without a high index of suspicion, early recognition and prompt intervention, catastrophic consequences can ensue, and mortality can be as high as 60% if jugular vein thrombosis or mediastinitis occurs. While older children may have specific complaints referable to the pharynx, infants and young children may present with vague symptoms. To date, a lot of emphasis continues to be placed on the importance of lateral soft tissue neck X-ray in the diagnosis and management of patients with suspected retropharyngeal abscesses; and lateral neck X-ray has been cited as the most useful radiological view of the laryngopharynx. While we recognise the role of lateral neck X-rays in retropharyngeal and other upper airway pathologies, we present three case series in which lateral neck X-rays were normal and diagnosis was made only after CT scanning. These three cases were unusual as the abscesses were located high in the naso-pharynx making them impossible to detect on the lateral soft tissue neck X-rays and this underscores the need for high index of suspicion and prompt CT or MRI scanning, in any child with symptoms or signs suggestive of a possible retropharyngeal abscess.

  10. Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients:medial or lateral?

    Institute of Scientific and Technical Information of China (English)

    Fatih Akbulut; Tolga Akman; Emre Salabas; Murat Diner; Mazhar Ortac; Ates Kadioglu

    2014-01-01

    The objective of this study was to compare the outcomes of the modiifed Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck’s fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck’s fascia above the urethra at the 5 and 7 o’clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients’ photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P=0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P=0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically signiifcant. Medial dissection of the bundle for the modiifed Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

  11. Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

    Directory of Open Access Journals (Sweden)

    Fatih Akbulut

    2014-06-01

    Full Text Available The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB to correct ventral congenital penile curvatures (CPCs. The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1 and 13 (Group 2 patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01. In Group 1, nine patients (42.8% required one diamond excision, 10 (47.6% required two diamond excisions and two (9.5% required more than two excisions; in Group 2, six patients (46.2% required two diamond excisions and seven patients (53.8% required more than two diamond excisions (P = 0.019. The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

  12. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma.

    Science.gov (United States)

    Wang, J B; Wu, K; Shi, L H; Sun, Y Y; Li, F B; Xie, L

    2017-10-01

    Postoperative hypocalcaemia due to dysfunction of the parathyroid glands is the most common complication after total thyroidectomy plus central neck dissection (CND). There is a lack of surgical techniques described to help preserve the inferior parathyroid gland in situ during CND. The objective of this study was to introduce the 'TBP layer' (layer of thymus-blood vessel-inferior parathyroid gland) concept for preserving the inferior parathyroid gland in situ during CND, and to evaluate its effectiveness. The study group included patients with primary papillary thyroid cancer who underwent total thyroidectomy with CND using the new surgical concept between January and December 2014. The control group included sex- and age-matched patients who underwent conventional total thyroidectomy with CND between January 2012 and December 2013. The proportion of inferior parathyroid glands preserved in situ and postoperative hypoparathyroidism rates in the two groups were compared. There were 181 patients in the study group and 306 in the control group. There were no significant differences between the groups in tumour size, multifocality, extrathyroidal extension, and number of harvested and metastatic central lymph nodes. The rate of inferior parathyroid gland preservation in situ was significantly improved from 37·9 to 76·3 per cent on the left side (P < 0·001), and from 52·0 to 77·9 per cent on the right side (P < 0·001), in the study group compared with the control group. The incidence of transient hypoparathyroidism decreased significantly from 35·0 to 7·2 per cent (P < 0·001). Applying the proposed surgical concept improved the rate of inferior parathyroid gland preservation in situ and decreased the incidence of transient postoperative hypoparathyroidism. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  13. [The role definition of lateral arm free flap in reconstruction after head and neck cancer surgery].

    Science.gov (United States)

    Li, C; Cai, Y C; Wang, W; He, Y X; Lan, X J; Li, Q L; Zhou, Y Q; Liu, J F; Zhu, G Q; Liu, K; Wang, S X; Wang, K; Fan, J C; Sun, R H

    2016-02-01

    Application of free flap is one of the important repair means in head and neck surgery. A variety of free flaps, such as anterolateral thigh flap, have showed unique advantages in repair for tissue defects after resection of head and neck tumor, and have became increasing popularity. Lateral arm flee flap is an important repair means in plastic surgery, which has developed more than 30 years, but the application of this flap for reconstruction in head and neck surgery is relatively backward, with few reports. This review focuses on the creativity and innovation, the relationship between anatomy and clinical application, and the application status and prospects for lateral arm flee flap in individual head and neck reconstruction surgery.

  14. Venous anastomosis in free flap reconstruction after radical neck dissection: is the external jugular vein a feasible option?

    Science.gov (United States)

    Reiter, Maximilian; Baumeister, Philipp

    2017-01-13

    Free microvascular tissue transfer has become a reliable and wellestablished technique in reconstructive surgery. Success rates greater than 95% are constantly reported in the literature. End-to-end anastomosis to the external jugular vein (EJ) is supposed to be equally successful as anastomosis to the internal jugular vein (IJ) in patients treated with selective neck dissection. No data has been published so far when the IJ had to be resected during neck dissection. The purpose of this study was to evaluate the success rate and complications of end-to-end anastomosis to the EJ in cases of (modified) radical neck dissection with resected IJ. A retrospective mono-center cohort study was performed. All patients with end-to-end anastomosis to either the IJ or EJ-system were reviewed. 423 free-tissue transfers performed between 2009 and 2016 were included. The overall success rate was 97.0% with an anastomotic revision rate due to venous thrombosis of 12.3%. In patients when the IJ had to be resected and the venous anastomosis was performed at the ipsilateral side to the EJ (n = 53), overall flap loss was significantly higher (5/53; 9.4%). The revision rate in these cases was 22.6%. Success rate of anastomosis to the EJ when the ipsilateral IJ was still intact was 100% (n = 20). Success rate when the anastomosis was performed at the contralateral side was 100%. End-to-end anastomosis to the EJ in cases with resected IJ is more likely to result in free flap loss. Furthermore, it is associated with a higher revision rate. Therefore, in cases with resected IJ, we suggest to plan the operation beforehand with anastomosis at the contralateral side whenever possible.

  15. Charcoal-induced granuloma that mimicked a nodal metastasis on ultrasonography and FDG-PET/CT after neck dissection

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Moon, Won Jin; Choi, Nami; Roh, Hong Gee; Kim, Mi Young; Kim, Na Ra; Moon, Sung Gyu; Chung, Hyun Woo; Lim, So Dug; Yang, Jung Hyun [Konkuk University Medical Center, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2015-02-15

    Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.

  16. Lateral neck injury assessments in side impact using post mortem human subject tests.

    Science.gov (United States)

    Yoganandan, Narayan; Humm, John; Pintar, Frank A; Wolfla, Christopher E; Maiman, Dennis J

    2011-01-01

    Current neck injury criteria are based on matching upper cervical spine injuries from piglet tests to airbag deployment loads and pairing kinematics from child dummies. These "child-based" scaled data together with adult human cadaver tolerances in axial loading are used to specify neck injury thresholds in axial compression and tension, and flexion and extension moment about the occipital condyles; no thresholds are specified for any other force or moment including lateral bending. The objective of this study was to develop a testing methodology and to determine the lateral bending moment injury threshold under coronal loading. Post mortem human subjects (PMHS) were used. Specimens consisted of whole body and isolated head-neck complexes with intact musculature. Intact specimen positioning included: sitting PMHS upright on a rigid seat, supporting the torso by a plate, maintaining Frankfurt plane horizontal. Isolated head-neck complexes were fixed at T1 with the occiput connected via a custom apparatus to a testing device to induce lateral bending motion. Head angular and linear accelerations and angular velocities were computed using a pyramid nine accelerometer package on the head; specimen-specific physical properties including center of gravity and moments of inertia in the three-dimensions; and equations of equilibrium. These data were used to determine neck loads at the occipital condyles. No specimens sustained injuries, identified by palpation, x-rays, CT, and autopsy. Results from 24 tests indicated that PMHS head-neck complexes can tolerate 75 Nm of coronal moment at low axial load without failure, and this level may be used as an initial estimate of the injury reference value under lateral loading to the human head-neck complex.

  17. Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review.

    Science.gov (United States)

    McLean, Timothy; Kerr, Stephen J; Giddings, Charles E B

    2017-09-01

    To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis. The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29-3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications. Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 127:2074-2080, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Spinal epidural abscess following glossectomy and neck dissection: A case report

    OpenAIRE

    Esther Cheng; Eric Thorpe; Richard Borrowdale

    2016-01-01

    Introduction: Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case: We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The...

  19. Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

    Directory of Open Access Journals (Sweden)

    Bong Il Rho

    2016-01-01

    Full Text Available There are two general categories of lateral osteotomy techniques—the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

  20. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report

    OpenAIRE

    TANAKA, Katsuhiro; Kanamaru, Hideki; Morikawa, Atsunori; Kawaguchi, Kenji

    2016-01-01

    Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebe...

  1. Elective neck dissection in oral carcinoma: a critical review of the evidence

    OpenAIRE

    Kowalski, LP; Sanabria, A

    2007-01-01

    More than 50% of patients with squamous cell carcinoma of the oral cavity have lymph node metastases and histological confirmation of metastatic disease is the most important prognostic factor. Among patients with a clinically negative neck, the incidence of occult metastases varies with the site, size and thickness of the primary tumour. The high incidence rate of occult cervical metastases (> 20%) in tumours of the lower part of the oral cavity is the main argument in favour of elective tre...

  2. The impact of virus in N3 node dissection for head and neck cancer.

    Science.gov (United States)

    Armas, Gian Luca; Su, Chih-Ying; Huang, Chao-Cheng; Fang, Fu-Min; Chen, Ching-Mei; Chien, Chih-Yen

    2008-11-01

    This study is to determine the impact of virus in surgical outcomes among patients of head and neck cancer with N3 lymph node metastasis. A retrospective analysis was conducted for 32 patients with operable N3 neck metastasis undergoing surgical treatment between January 1987 and October 2006. The nuclei of the tumor cells were investigated for the presence of human papillomavirus (HPV) and Epstein-Barr virus (EBV) DNAs and were taken into account as the variable for survival analysis. The primary sites were oropharynx in 11 patients, tongue in 3, buccal mucosa in 1, hypopharynx in 8 and unknown primary in 9. The five-year cumulative overall survival rate was 40.7% and 5-year cumulative regional control rate was 55.8%. The 5-year cumulative overall survival rate of patients with unknown primary site (72.9%) and HPV or EBV positive in the tumor (77.8%) were significantly higher than those patients with known primary site (31.3%) and HPV or EBV negative in the tumor (27.4%), respectively (P = 0.0335 and P = 0.0348, log rank test). In conclusion, surgery with adjuvant therapy offers reasonable outcomes for operable N3 node in head and neck cancer in our cohort. In addition, patients with HPV or EBV positive in the tumor have a better survival.

  3. No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression.

    Science.gov (United States)

    Maquieira, R; Haerle, S K; Huber, G F; Soltermann, A; Haile, S R; Stoeckli, S J; Broglie, Martina A

    2016-07-01

    The aim of the study was to assess regional control and survival in primary irradiated oropharyngeal cancer patients with advanced neck disease (≥cN2a) receiving planned neck dissection (PND) irrespective of the nodal response compared to salvage neck dissection (SND) in case of regional persistence or reccurence in relation to tumoral p16 overexpression. 96 consecutive patients treated at the University Hospital of Zurich, Switzerland were included. Tissue microarray-based scoring of p16 expression was obtained. 5 years overall (OS) and disease-specific survival (DSS) in the PND and SND cohort were 70 vs. 57 % (p = 0.20) and 80 vs. 65 % (p = 0.14), respectively. Regional control in PND and SND achieved 95 vs. 87 % (p = 0.29), respectively. There was no statistically significant impact of neck treatment (PND vs. SND) on regional control or survival among patients with p16-negative tumors (5 years OS 59 vs. 50 %, p = 0.66; 5 years DSS 59 vs. 57 %, p = 0.89) nor among patients with p16-positive tumors (5 years OS 84 vs. 67 %, p = 0.21; 5 years DSS 95 vs. 81 %, p = 0.24). The type of neck dissection after primary intensity-modulated radiotherapy (IMRT) had no impact on regional control and survival even in human papillomavirus (HPV)-associated disease. Therefore we are convinced that based on the accuracy of newer diagnostic modalities the surveillance of a radiologically negative neck after primary chemoradiation (CRT) is oncologically safe irrespective of p16 expression of the tumor.

  4. Carotid dissection (image)

    Science.gov (United States)

    ... This leaking of blood into the artery wall (dissection) may cause a clot to form, reducing blood ... the neck, which means stroke secondary to carotid dissection may occur in young people as well as ...

  5. 改良根治性颈清在甲状腺癌中的应用%The Use of Modified Radical Neck Dissection in Thyroid Cancer

    Institute of Scientific and Technical Information of China (English)

    王可敬

    2001-01-01

    在甲状腺癌的治疗中,改良根治性颈清术比传统根治性颈清术能保留较多的功能,又不影响肿瘤的根治。它适用于甲状腺髓样癌、分化性甲状腺癌及部分甲状腺微小癌,而对未分化癌是否有必要尚有争议。%In the treatment of thyroid cancer, modified radical neck dissection(MRND) can offer much function than traditional radical neck dissection (RND) do, and it doesn't affect the radical operation. MRND is suitable for medullary cancer, differentiated cancer and some microcarci noma of thyroid, but MRND for undifferentiated thyroid cancer is controversial.

  6. Impact of Iymph node metastases identified on central neck dissection (CND) on the recurrence of papillary thyroid cancer: potential role of BRAFV600E mutation in defining CND

    OpenAIRE

    Alzahrani, Ali S.; XING, MINGZHAO

    2013-01-01

    The impact of metastasized cervical lymph nodes (CLN) identified on central neck dissection (CND) on the recurrence/persistence of papillary thyroid cancer (PTC) and the extent of CND needed to reduce recurrence/persistence have not been firmly established. To assess the impact of CLN metastasis and BRAF mutation on the recurrence/persistence of PTC and the potential of BRAF mutation in assisting CND, we analysed data of 379 consecutive patients with PTC who underwent thyroidectomy with (n=24...

  7. Pathologic features of metastatic lymph nodes identified from prophylactic central neck dissection in patients with papillary thyroid carcinoma.

    Science.gov (United States)

    Lee, Hyoung Shin; Park, Chanwoo; Kim, Sung Won; Noh, Woong Jae; Lim, Soo Jin; Chun, Bong Kwon; Kim, Beom Su; Hong, Jong Chul; Lee, Kang Dae

    2016-10-01

    The importance of pathologic features of metastatic lymph nodes (LNs), such as size, number, and extranodal extension, has been recently emphasized in patients with papillary thyroid carcinoma (PTC). We evaluated the characteristics of metastatic LNs identified after prophylactic central neck dissection (CND) in patients with PTC. We performed a retrospective review of 1,046 patients who underwent unilateral or bilateral thyroidectomy with ipsilateral prophylactic CND. We reviewed the characteristics of the metastatic LNs and analyzed their correlation to the clinicopathologic characteristics of the primary tumor. Cervical LN metastasis after prophylactic CND was identified in 280 out of 1046 patients (26.8 %). The size of metastatic foci (≥2 mm) was independently correlated with primary tumor size (≥1 cm) (p = 0.016, OR = 1.88). Primary tumor size (≥1 cm) was also correlated to the number of metastatic LNs (≥5) (p = 0.004, OR = 3.14) and extranodal extension (p = 0.021, OR = 2.41) in univariate analysis. The size of the primary tumor affects pathologic features of subclinical LN metastasis in patients with PTC. Patients with primary tumors ≥1 cm have an increased risk of larger LN metastases (≥2 mm), an increased number of LN metastases (≥5), and a higher incidence of ENE, which should be considered in decision for prophylactic CND.

  8. Neck and shoulder function in patients treated for oral malignancies: A 1-year prospective cohort study

    NARCIS (Netherlands)

    Speksnijder, C.M.; Bilt, A. van der; Slappendel, M.; Wijer, A. de; Merkx, M.A.W.; Koole, R.

    2013-01-01

    BACKGROUND: Neck and shoulder complaints can be a direct result of a neck dissection. METHODS: Maximal active lateral flexion of the neck, forward flexion and abduction of the shoulder, and self-perceived function were determined in 145 patients treated for oral cancer. RESULTS: No short-term

  9. Simultaneous bilateral neck dissection:a report of 38 cases%同期双侧颈淋巴清扫术38例分析

    Institute of Scientific and Technical Information of China (English)

    邹杰; 王凯; 张波; 胡季洋

    2011-01-01

    Objective:To explore the surgical approach, indications and perioperative management of simultaneous bilateral neck dissection. Methods:Among 38 patients with simultaneous bilateral neck dissection, 37 cases were treated by simultaneous bilateral neck dissection or selective neck dissection, only 1 by unilateral radical neck dissection and contralateral functional neck dissection.Results:There was no operative death in this group. Postoperative complications included:l wound bleeding;2 unilateral chylous fistulas which were recovery by way of expectant treatment with vacuum suction; 1 experienced tracheotomy on 3rd day after the operation of bilateral thyroid cancer, on half a year after the tube removed and left hospital who experienced tracheotomy because of difficulty breathing and permanent reserved the tube ;2 experienced pharyngeal fistula, among of 2,1 was recovery after expectant treatment and 1 recovery after reconstructed with pedicle pectoralis major myocutaneous flap. The lymph node positive number is from 0 to 12,average 4/cases;21 cases bilateral neck lymph node were positive, 11 unilateral lymph node positive and contralateral negative,6 bilateral lymph node negative. Conclusions:If the operation indication is restrictedly controlled, adequate perioperative preparation and timely,correct perioperative management. Simultaneous bilateral neck dissection is safe, eliminating pain of two-stage operation, retrenching payment for medical care.%目的:探讨同期双侧颈淋巴清扫术的手术方法、适应证及围手术期处理.方法:38例行同期双侧颈淋巴清扫术患者,其中37例采用双侧功能性颈淋巴清扫或分区性颈淋巴清扫,仅1例行一侧根治性颈淋巴清扫,另一侧行功能性颈淋巴清扫.结果:全组无一例手术死亡.术后创口出血1例,出现一侧乳糜瘘2例,经负压吸引保守治疗痊愈.1例双甲癌术后第3天气管切开,拔管出院后半年出现呼吸困难,行气管切

  10. Relationship Between Muscle Dissection Method and Postoperative Muscle Atrophy in the Lateral Suboccipital Approach to Vestibular Schwannoma Surgery.

    Science.gov (United States)

    Ogiwara, Toshihiro; Goto, Tetsuya; Aoyama, Tatsuro; Hara, Yosuke; Nagm, Alhusain; Tanaka, Yuichiro; Hongo, Kazuhiro

    2016-10-01

    Various techniques are available for occipital skull exposure with muscle dissection, as well as different types of skin incisions in the lateral suboccipital approach to vestibular schwannoma (VS) surgery. The skin incisions are generally classified as S-shaped, J-shaped, or C-shaped. In each method, the technique used for muscle dissection differs in terms of cut, single layer, and multiple layers. This study was performed to identify the relationships among muscle dissection method, skin incision type, and muscle atrophy in the lateral suboccipital approach to surgery for VS. Between 2002 and 2011, we performed surgical resection in 53 patients with VS at Shinshu University Hospital. Of these 53 patients, 35 with radiographic annual follow-up for >3 years after surgery were evaluated retrospectively. These patients included 14 who underwent an S-shaped incision, 6 with a J-shaped incision, and 15 with a C-shaped incision. Bilateral areas of the skin and occipital muscles were measured, and rates of atrophy were calculated and compared among the 3 methods. Postoperative muscle atrophy was significantly advanced in the second postoperative year, but did not tend to develop further after the third year. The postoperative muscle atrophy ratio was significantly lower in the C-shaped incision group (mean ± SD, 4.0% ± 6.9%) compared with the S-shaped (17.1% ± 9.8%) and J-shaped (17.6% ± 10.0%) incision groups within 2 years after surgery (P muscle dissection was associated with significantly reduced postoperative muscle atrophy compared with the other methods. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

    Directory of Open Access Journals (Sweden)

    Palmieri Giovanni

    2010-11-01

    Full Text Available Abstract Background Endoscopic submucosal dissection (ESD is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence. Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications. Case Presentation We successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs. ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces of the central part of the tumour. In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up. Conclusions In the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

  12. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report.

    Science.gov (United States)

    Tanaka, Katsuhiro; Kanamaru, Hideki; Morikawa, Atsunori; Kawaguchi, Kenji

    2016-10-01

    Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebellar artery. After emergent endovascular patent artery occlusion, he developed Wallenberg syndrome and experienced apnea and a conscious disturbance episode due to CHS on postoperative days 6 and 16. Intensive respiratory care including intubation, tracheostomy, mechanical ventilation, and rehabilitation prevented subsequent recurrence of apnea and the CHS resolved completely. CHS after unilateral medullary infarction involving respiratory centers tends to occur in the acute and subacute phase and may be lethal without careful respiratory management.

  13. Treatment experience of chylous fistula after neck dissection%颈淋巴结清扫术后乳糜漏的治疗

    Institute of Scientific and Technical Information of China (English)

    董国伟; 韩新光

    2012-01-01

    Objective To investigate the management and prevention of the chylous fistula after neck dissection. Methods Totally 289 cases were performed neck dissection, among them, 11 had chylous fistula were retrospectively analyzed. Results The occurrence rate of chylous fistula was 3. 82% . 9 cases accepted conservative treatment, and 2 cases were reoperaled successfully. Conclusions Technique anil familiarity on anatomy with the careful operation is the key to prevent chylous fistula. The main points of the management for chylous fistula are prevention in operation, early diagnosis and management in time.%目的 探讨颈淋巴结清扫术后乳糜漏的防治方法.方法 回顾性分析了289例颈淋巴清扫手术术后发生乳糜漏11例患者的临床资料 结果 乳糜漏的发生率为发生率3.82%,9例经保守治疗治愈,2例经再次手术治愈.结论 术者对解剖的熟悉程度和谨慎的手术操作是预防发生乳糜瘘的关键,颈淋巴结清扫术后的乳糜漏应及早诊断,术中应加强预防并及时处理.

  14. Effects of the KIF2C neck peptide on microtubules: lateral disintegration of microtubules and β-structure formation.

    Science.gov (United States)

    Shimizu, Youské; Shimizu, Takashi; Nara, Masayuki; Kikumoto, Mahito; Kojima, Hiroaki; Morii, Hisayuki

    2013-04-01

    Members of the kinesin-13 sub-family, including KIF2C, depolymerize microtubules. The positive charge-rich 'neck' region extending from the N-terminus of the catalytic head is considered to be important in the depolymerization activity. Chemically synthesized peptides, covering the basic region (A182-E200), induced a sigmoidal increase in the turbidity of a microtubule suspension. The increase was suppressed by salt addition or by reduction of basicity by amino acid substitutions. Electron microscopic observations revealed ring structures surrounding the microtubules at high peptide concentrations. Using the peptide A182-D218, we also detected free thin straight filaments, probably protofilaments disintegrated from microtubules. Therefore, the neck region, even without the catalytic head domain, may induce lateral disintegration of microtubules. With microtubules lacking anion-rich C-termini as a result of subtilisin treatment, addition of the peptide induced only a moderate increase in turbidity, and rings and protofilaments were rarely detected, while aggregations, also thought to be caused by lateral disintegration, were often observed in electron micrographs. Thus, the C-termini are not crucial for the action of the peptides in lateral disintegration but contribute to structural stabilization of the protofilaments. Previous structural studies indicated that the neck region of KIF2C is flexible, but our IR analysis suggests that the cation-rich region (K190-A204) forms β-structure in the presence of microtubules, which may be of significance with regard to the action of the neck region. Therefore, the neck region of KIF2C is sufficient to cause disintegration of microtubules into protofilaments, and this may contribute to the ability of KIF2C to cause depolymerization of microtubules.

  15. ES2 neck injury assessment reference values for lateral loading in side facing seats

    NARCIS (Netherlands)

    Philippens, M.M.G.M.; Wismans, J.S.H.M.; Forbes, P.A.; Yoganandan, N.; Pintar, F.; Soltis, S.J.

    2009-01-01

    Injury assessment reference values (IARV) predicting neck injuries are currently not available for side facing seated aircraft passengers in crash conditions. The aircraft impact scenario results in inertial loading of the head and neck, a condition known to be inherently different from common autom

  16. Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases.

    Science.gov (United States)

    Bozec, Alexandre; Dassonville, Olivier; Chamorey, Emmanuel; Poissonnet, Gilles; Sudaka, Anne; Peyrottes, Isabelle; Ettore, Francette; Haudebourg, Juliette; Bussière, Françoise; Benisvy, Danielle; Marcy, Pierre-Yves; Sadoul, Jean Louis; Hofman, Paul; Lassale, Sandra; Vallicioni, Jacques; Demard, François; Santini, José

    2011-08-01

    The impact of cervical lymph node metastases and the optimal surgical management of the neck in patients with papillary thyroid carcinoma (PTC) remain controversial. The objectives of this retrospective study were to determine, in patients with PTC, the predictive factors and the impact on tumor recurrence rate of cervical lymph node involvement, and to evaluate the oncologic results and the morbidity of central neck dissection (CND). We reviewed the records of patients who had undergone surgical treatment for PTC at our institution between 1990 and 2000. A total of 368 patients (86 men and 282 women) were included in this study. Young age (p = 0.02), tumor size (p = 0.001) and extrathyroidal tumor extension (p = 0.003) were significant predictive factors of cervical lymph node metastatic involvement (multivariate analysis). Initial metastatic cervical lymph node involvement was identified as an independent risk factor of tumor recurrence (multivariate analysis, p = 0.01). Metastatic lymph node(s) were found in prophylactic CND specimens in 31% of the patients. CND increased the risk of postoperative hypocalcemia (p = 0.008) and of permanent hypoparathyroidism (p = 0.002). In conclusion, cervical lymph node metastatic involvement at the time of initial surgery is an independent risk factor of tumor recurrence. CND provided an up-staging of more than 30% of patients with a clinically N0 neck, but was associated with significant morbidity regarding parathyroid function.

  17. 微小乳头状甲状腺癌行颈淋巴结清扫术的必要性探讨%Study on the necessity of neck dissection for papillary thyroid microcarcinoma

    Institute of Scientific and Technical Information of China (English)

    于杰; 刘卓; 孙尧

    2012-01-01

    -ly. Recurrence occurred in one unifocal case 42 months later and one multifocal case 7 months later. No death occurred during the follow - up period of all patients. Conclusions Neck dissection should be aggressively performed in patients with multifocal papillary thyroid microcarcinoma. However, prophylactic neck dissection is not necessary for unifocal cases under regularly follow -up care, because that has no influence on the survival rate but can improve quality of life.

  18. Multidisciplinary treatment of the neck

    NARCIS (Netherlands)

    de Bree, Remco; Langendijk, Johannes A.; Leemans, C. R.

    2016-01-01

    Since lymph node metastases are one of the most important prognostic factors, treatment of the neck is challenging. In clinically N0 neck, (super)selective neck dissection is indicated, whereas a more extensive neck dissection with preservation of important structures is performed in N2-N3 disease.

  19. Spinal accessory nerve neuropathy following neck dissection Neuropatia do nervo acessório espinhal secundária à cirurgia de esvaziamento cervical

    Directory of Open Access Journals (Sweden)

    Luciana Pereira de Lima

    2011-04-01

    Full Text Available Tthe most common complication of neck dissection is shoulder dysfunction due to manipulation of spinal accessory nerve, resulting in trapezius muscle atrophy mainly in procedures involving the posterior neck triangle. AIM: This study used electromyography to evaluate the injury to the spinal accessory nerve following neck dissection. MATERIALS AND METHODS: Prospective case series of 51 patients submitted to 60 neck dissections followed by physical therapy evaluation of shoulder dysfunction. Nerve integrity was evaluated before and after the surgery by means of surface EMG registering the electric activity of the trapezius muscle during voluntary contraction. The patients were grouped according to the type of neck dissection, presence of shoulder pain, impairment during abduction movement and hypotrophy/atrophy of the trapezius muscle. RESULTS: Action potential had median values of 54.3 microV before surgery and 11.6 microV after it (pUma das complicações mais comuns do esvaziamento cervical é a disfunção do ombro devido à manipulação do nervo acessório, que resulta na atrofia do músculo trapézio. OBJETIVO: Avaliar com eletromiografia de superfície (EMGs a lesão do XI par decorrente do esvaziamento cervical. MATERIAL E MÉTODO: Estudo prospectivo com 51 pacientes (60 esvaziamentos cervicais tratados de câncer de cabeça e pescoço. A função do nervo acessório foi avaliada no período pré e pós-operatório com registro da atividade elétrica das fibras descendentes do músculo trapézio em contração isométrica voluntária máxima. Os pacientes foram agrupados pelo tipo de esvaziamento e movimento de abdução do braço. RESULTADOS: O potencial de ação apresentou mediana de 54,3 microV no pré-operatório e 11,6 microV no pós-operatório (p<0,001. Os valores registrados no pós-operatório apresentaram decréscimo médio de 70% (20% a 94% em relação aos valores pré-operatórios. Com relação à extensão do EC, foram

  20. Is neck pain associated with worse health-related quality of life 6 months later? A population-based cohort study

    DEFF Research Database (Denmark)

    Nolet, P. S.; Cote, P.; Kristman, V. L.

    2015-01-01

    BACKGROUND CONTEXT: Current evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. PURPOSE: The purpose of this study was to investigate...... the association between increasing grades of neck pain severity and HRQoL 6 months later. In addition, this longitudinal study examines the crude association between the course of neck pain and HRQoL. STUDY DESIGN: This is a population-based cohort study. PATIENT SAMPLE: Eleven hundred randomly sampled...... Questionnaire to measure neck pain and its related disability. The SF-36 questionnaire was used to measure physical and mental HRQoL 6 months later. Multivariable linear regression was used to measure the association between graded neck pain and HRQoL while controlling for confounding. Analysis of variance...

  1. Molecular dissection of the migrating posterior lateral line primordium during early development in zebrafish

    Directory of Open Access Journals (Sweden)

    Villablanca Eduardo J

    2010-12-01

    Full Text Available Abstract Background Development of the posterior lateral line (PLL system in zebrafish involves cell migration, proliferation and differentiation of mechanosensory cells. The PLL forms when cranial placodal cells delaminate and become a coherent, migratory primordium that traverses the length of the fish to form this sensory system. As it migrates, the primordium deposits groups of cells called neuromasts, the specialized organs that contain the mechanosensory hair cells. Therefore the primordium provides both a model for studying collective directional cell migration and the differentiation of sensory cells from multipotent progenitor cells. Results Through the combined use of transgenic fish, Fluorescence Activated Cell Sorting and microarray analysis we identified a repertoire of key genes expressed in the migrating primordium and in differentiated neuromasts. We validated the specific expression in the primordium of a subset of the identified sequences by quantitative RT-PCR, and by in situ hybridization. We also show that interfering with the function of two genes, f11r and cd9b, defects in primordium migration are induced. Finally, pathway construction revealed functional relationships among the genes enriched in the migrating cell population. Conclusions Our results demonstrate that this is a robust approach to globally analyze tissue-specific expression and we predict that many of the genes identified in this study will show critical functions in developmental events involving collective cell migration and possibly in pathological situations such as tumor metastasis.

  2. Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection: A comparative clinical study

    Directory of Open Access Journals (Sweden)

    Abhishek Ghosh

    2015-01-01

    Full Text Available Introduction: Comparison between stainless steel staples and silk sutures for primary closure of skin in patients undergoing neck dissection, in context of rapid application, approximation of the skin edges, economy and aesthetics of the resultant scar. Aim: (1 To compare surgical stainless steel staples and silk sutures for primary wound closure, with respect to presence/absence of wound infection and dehiscence (2 To compare the resultant scar following the two different methods of the closure at 3 rd month postoperatively with the help of visual analog scale and analyze the result statistically Design: This study was designed to compare skin closure using staples and silk sutures in patients undergoing neck dissection, using both methods in one-half of the same wound; thus each wound affording its own control. Materials and Methods: The study was conducted on patients requiring collar line incision (high submandibular incision with or without a cephalad extension of midline lower lip split incision for surgical access, who presented to the Department of Oral and Maxillo-Facial Surgery. (1 Sample size: 10 (2 Study design: Prospective Comparative study (3 Study duration: One and half years (4 Surgical stainless steel staples: Proximate Plus MD 35 W, Ethicon Endo Surgery (5 Sutures: 3-0 Ethiprime NW 5003, Non-Absorbable Surgical Suture, Mersilk-90 cm, Ethicon, (16 mm 3/8 circle cutting needle. Conclusion: It wass concluded that there is no significant difference between the scars observed in the regions of incision which underwent primary closure by two different methods, that is surgical stainless steel staples and 3-0 Mersilk Sutures.

  3. Application of an extended collar incision in neck dissection for differentiated thyroid cancer%采用领式皮纹延长切口进行甲状腺癌颈淋巴结清扫

    Institute of Scientific and Technical Information of China (English)

    张彬; 鄢丹桂; 安常明; 徐震纲; 唐平章

    2009-01-01

    Objective To explore a cosmetic incision in the neck dissection for differentiated thyroid carcinoma. Methods An extended collar incision was used for neck dissection in 82 consecutive patients with thyroid carcinoma from May 1999 to December 2006. The incision was designed to start as a conventional thyroid collar incision, and then to extend it along the skin crease to the anterior border of trapezium, so to avoid the vertical limb of conventional hockey stick incision. There were 60 females and 22 males in this series, with a median age of 40.5 years (range, 10 to 80 years). Ninety-six procedures of neck dissection were performed in 82 patients, including one radical neck dissection, one type Ⅰ modified neck dissection, 8 type Ⅱ modified neck dissections, and 86 type Ⅲ modified neck dissections. Results The average time of anesthesia was 197 minutes. The average dissected lymph nodes were 37.5, with average metastasis in 8.8 nodes. Eight patients (9.8%) developed complications related to neck dissection. The follow-up period in these patients were 1 to 96 months with a median follow-up time of 23 months. Cervical recurrence was found in only one patient (1.2%). Neither death nor distant metastasis was observed in this series. Conclusion It is feasible to perform a modified neck dissection for differentiated thyroid cancer through the extended collar incision. The preliminary results show that the above described incision is not only oncologically safe, but also offers a cosmetic benefit for the patient with thyroid carcinoma.%目的 探索甲状腺癌颈清扫术术后更加美观的手术切口.方法 对82例分化型甲状腺癌患者采用领式皮纹延长切口行改良颈清扫术.在常规甲状腺领式切口的基础上,在颈清扫侧沿皮纹延长到斜方肌前缘位置,避免曲棍球棒切口的垂直段.82例患者共行颈清扫术96侧,术式分别是根治性颈清扫术1侧,改良性颈清扫术Ⅰ型1侧,改良性颈清扫术Ⅱ型8

  4. Prevention and management for chylous fistula after neck dissection%颈清术后乳糜瘘的预防及治疗

    Institute of Scientific and Technical Information of China (English)

    林存红; 李怀生; 于延兴; 李龙

    2009-01-01

    Objective:To evaluate prevention and management for chylous fistulas undergoing dissection. Methods:The clinical materials of 11 cases chylous fistulas after 493 cases neck dissection were analyzed retrospectively from September 1994 to March 2008. Results:Of 11 chylous fistulas, 9 were left-sided and 2 were right-sided. Surgery 3(surgery seam grips 1 case again directly,surgery seam grips and muscle petal pads 2 cases), homogeneous time cicatrization. Conservative therapy which included closed-wound drainage and local pressure dressing and/or low-fat nutritional support was employed in 8 cases, 7 cases were successfully treated, the average duration time for healing was 10 days(4-21 days), the remaining 1 case failed to had and were further treated surgically. Conclusion:The key of reduce fistulas is familiar anatomy for neck dissection. Chylous fistula can be cured after positive and reasonable conservative and/or surgical treatment.%目的:探讨颈清术后乳糜瘘的预防及治疗措施.方法:回顾性分析泰安市肿瘤防治院外科1994年9月~2008年3月493例颈清术后11例乳糜瘘的临床资料,评价乳糜瘘的治疗效果.结果:11例乳糜瘘中左侧9例,右侧2例;直接再手术3例(手术缝扎1例,手术缝扎并肌瓣填塞2例),均一期愈合;8例采用负压吸引、局部加压及低脂饮食的保守治疗,其中7例获得痊愈,平均愈合时间为10天(4~21天),1例失败,经手术治疗(肌瓣填塞)而痊愈.结论:熟悉颈部胸导管解剖、提高手术技巧是减少颈清术后乳糜瘘发生的关键;乳糜瘘经积极而合理的保守治疗或手术治疗是可以治愈的.

  5. Aortic dissection

    Science.gov (United States)

    Aortic aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - dissection ... the chest and abdomen (the descending aorta). Aortic dissection most often happens because of a tear or ...

  6. MRI and MR angiography of vertebral artery dissection

    Energy Technology Data Exchange (ETDEWEB)

    Mascalchi, M. [Cattedra di Radiologia, Universita di Pisa (Italy); Bianchi, M.C. [Servizio di Neuroradiologia, Ospedale S. Chiara, Pisa (Italy); Mangiafico, S. [Servizio di Neuroradiologia, Ospedale di Careggi, Firenze (Italy); Ferrito, G. [Servizio di Neuroradiologia, Ospedali Riuniti, Livorno (Italy); Puglioli, M. [Servizio di Neuroradiologia, Ospedale S. Chiara, Pisa (Italy); Marin, E. [Servizio di Radiologia, Ospedale S. M. Nuova, Firenze (Italy); Mugnai, S. [Clinica Neurologica, Universita di Firenze (Italy); Canapicchi, R. [Servizio di Neuroradiologia, Ospedale S. Chiara, Pisa (Italy); Quilici, N. [Servizio di Neuroradiologia, Ospedali Riuniti, Livorno (Italy); Inzitari, D. [Clinica Neurologica, Universita di Firenze (Italy)

    1997-05-01

    A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3-20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients. (orig.). With 7 figs., 3 tabs.

  7. Evaluating the influence of prophylactic central neck dissection on TNM staging and the recurrence risk stratification of cN0 differentiated thyroid carcinoma.

    Science.gov (United States)

    Lin, Xiaodong; Chen, Xiaoyi; Jiru, Yuan; Du, Jialin; Zhao, Gang; Wu, Zeyu

    2016-06-01

    The purpose of this study was to explore the risk factors that were associated with central lymph node metastasis (CLNM) in patients with clinical nodal negative differentiated thyroid carcinoma (cN0 DTC) after prophylactic central neck dissection (pCND). The influence of pCND on TNM staging and recurrence risk stratification (RRS) in patients with cN0 DTC was also evaluated in our study. A total of 153 cN0 DTC patients in Guangdong general hospital who underwent thyroidectomy with pCND from March 2014 to October 2014 were enrolled in this study. The relations of CLNM with clinicopathologic characteristics of cN0 DTC were analyzed by univariate and multivariate logistic regression. The influence of pCND on migration of TNM staging and RRS in cN0 DTC was observed. In the present study, CLNM was found in 42.5% (65 of 153 cases) of patients with cN0 DTC. On univariate analysis, the age less than 45 years old, tumor size more than 2cm, pT staging, and a total number of central lymph nodes dissected more than 3 were significantly associated with CLNM (P0.05). On multivariate logistic regression, age3 (P=0.002) were significantly associated with CLNM. Because of the identification of CLNM in the implementation of pCND, 15 (9.8%) of 153 cN0 DTC patients were upgraded in TNM staging; all these patients were older than 45 years. Fifty-six patients (36.6%) developed higher RRS (from low to intermediate) after pCND. For younger patients (ageTNM staging (for patients with age≥45 years) and RRS. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  8. Impact of lymph node metastases identified on central neck dissection (CND) on the recurrence of papillary thyroid cancer: potential role of BRAFV600E mutation in defining CND.

    Science.gov (United States)

    Alzahrani, Ali S; Xing, Mingzhao

    2013-02-01

    The impact of metastasized cervical lymph nodes (CLN) identified on central neck dissection (CND) on the recurrence/persistence of papillary thyroid cancer (PTC) and the extent of CND needed to reduce recurrence/persistence have not been firmly established. To assess the impact of CLN metastasis and BRAF mutation on the recurrence/persistence of PTC and the potential of BRAF mutation in assisting CND. Analyses of 379 consecutive patients with PTC who underwent thyroidectomy with (n=243) or without CND (n=136) at a tertiary-care academic hospital during the period 2001-2010 for their clinicopathological outcomes and BRAF mutation status. Increasingly aggressive tumor characteristics were found as the extent of CND was advanced following conventional risk criteria from non-CND to limited CND to formal CND. Disease recurrence/persistence rate also sharply rose from 4.7% to 15.7% and 40.5% in these CND settings respectively (PCND to formal CND (PCND. A strong association of CLN metastasis and BRAF mutation with disease recurrence/persistence was revealed on Kaplan-Meier analysis and BRAF mutation strongly predicted CLN metastasis. CLN metastases found on CND are closely associated with disease recurrence/persistence of PTC, which are both strongly predicted by BRAF mutation. Current selection of PTC patients for CND is appropriate but higher extent of the procedure, once selected, is needed to reduce disease recurrence, which may be defined by combination use of preoperative BRAF mutation testing and conventional risk factors of PTC.

  9. Clinical Observation of Minimally Invasive Endoscopy-Assisted Neck Dissection for Thy-roid Papillary Carcinoma%内镜辅助下颈部清扫术对甲状腺乳头状癌的疗效观察

    Institute of Scientific and Technical Information of China (English)

    张卫东; 孙雪峰; 李晓丽; 王艳丽

    2014-01-01

    Objective To observe the efficacy and safety of minimally invasive endoscopy-assisted neck dissection for thyroid papillary carcinoma ( PTC) .Methods 36 cases of PTC received minimally invasive endoscopy-assisted lateral neck dis-section,the process was the same as the conventional operation .Psychological intervention were done during perioperative period . SAS and SDS were used to evaluate psychological health of patients before and after psychological intervention .Results The mean incision was (5.3 ±0.4 )cm,mean operative time was 3.6 h,average postoperative wound drainage was 208 ml,and aver-age time to pull out the drainage tube was 5.2d,there had no severe postoperative complications .According to the postoperative pathological report,average(26.8 ±15.1)lymph node were cleaned during the procedure .SAS and SDS scores after psychological intervention decreased significantly than before (P<0.001).No residual or recurrent disease was found in (23.7 ±8.2)months follow up time.Conclusion Minimally invasive endoscopy-assisted neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results .Psychological intervention can improve the symptoms of anxiety and depression of patients.%目的:观察内镜辅助下颈部小切口颈部清扫术治疗甲状腺乳头状癌的安全性和治疗效果。方法对36例甲状腺乳头状癌患者进行内镜辅助下甲状腺切除和颈清扫术,过程与常规手术相同。围手术期进行心理干预,心理干预前后分别采用SAS和SDS测评患者心理健康水平。结果手术切口平均长度为(5.3±0.4)cm,手术平均时间为(4.2±0.6) h,术后平均伤口引流量为(208±53) ml,平均拔出引流管时间为(5.2±1.5) d,术后未发生严重并发症。据术后病理报告显示内镜平均清扫淋巴结(26.8±15.1)枚。心理干预后患者SAS和SDS得分与干预前相比明显降低( P<0.001

  10. Recruitment properties and significance of short latency reflexes in neck and eye muscles evoked by brief lateral head accelerations.

    Science.gov (United States)

    Colebatch, James G; Dennis, Danielle L; Govender, Sendhil; Chen, Peggy; Todd, Neil P McAngus

    2014-09-01

    Short lateral head accelerations were applied to investigate the recruitment properties of the reflexes underlying the earliest ocular and cervical electromyographic reflex responses to these disturbances. Components of both reflexes are vestibular dependent and have been termed "ocular vestibular evoked myogenic potentials" and "cervical vestibular evoked myogenic potentials", respectively. Previous investigations using a unilateral vestibular stimulus have indicated that some but not all these vestibular-dependent reflexes show a simple power law relationship to stimulus intensity. In particular, crossed otolith-ocular reflexes showed evidence of an inflection separating two types of behaviour. The present stimulus acts bilaterally, and only the earliest crossed otolith-ocular reflex, previously shown to have a strictly unilateral origin, showed evidence of an inflection. Reflex changes in ocular torsion could, in principle, correct for the changes associated with translation for an elevated eye, but our findings indicated that the responses were consistent with previous reports of tilt-type reflexes. For the neck, both vestibular and segmental (muscle spindle) reflexes were evoked and followed power law relationships, without any clear separation in sensitivity. Our findings are consistent with previous evidence of "tilt-like" reflexes evoked by lateral acceleration and suggest that the departure from a power law occurs as a consequence of a unilateral crossed pathway. For the neck, responses to transients are likely to always consist of both vestibular and non-vestibular (segmental) components. Most of the translation-evoked ocular and cervical reflexes appear to follow power law relationship to stimulus amplitude over a physiological range.

  11. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    2004-01-01

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of se

  12. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of

  13. Significance of Size of Persistent/Recurrent Central Nodal Disease on Surgical Morbidity and Response to Therapy in Reoperative Neck Dissection for Papillary Thyroid Carcinoma.

    Science.gov (United States)

    Lang, Brian Hung-Hin; Shek, Tony W H; Chan, Angel On-Kei; Lo, Chung-Yau; Wan, Koon Yat

    2017-01-01

    To balance the risk of disease progression, morbidity, and efficacy of reoperative central neck dissection (RCND) in papillary thyroid carcinoma, the latest clinical guidelines recommend early surgery over surveillance when the largest diseased node is >8 mm in its smallest dimension. However, the evidence remains scarce. To determine an appropriate size for first-time RCND, the relationship between size of largest diseased central node, morbidity, and response-to-therapy following RCND was examined. A total of 130 patients who underwent RCND following initial surgery for persistent/recurrent nodal disease were reviewed. Patients with largest diseased central node measured preoperatively by ultrasonography were included. Eligible patients were categorized into three groups: largest central node 15 mm (group III). Surgical morbidity and response to therapy at one year after RCND were compared between groups. To evaluate biochemical response, patients with structural incompleteness were excluded. Group III not only had significantly more high-risk tumors (by American Thyroid Association risk stratification) at initial therapy (64.5% vs. 44.4%, respectively; p = 0.038), but this group also a higher risk of extranodal extension (35.5% vs. 16.0%; p = 0.055), recurrent laryngeal nerve involvement (19.4% vs. 0.0%; p 15 mm in the largest disease central node was an independent risk factor for incomplete biochemical response, while nodal size 10-15 mm was not. These findings imply that the recommended threshold of 8 mm might be too stringent and could be raised to 15 mm without increasing the surgical morbidity from RCND.

  14. Evaluating a novel cervical orthosis, the Sheffield Support Snood, in patients with amyotrophic lateral sclerosis/motor neuron disease with neck weakness.

    Science.gov (United States)

    Baxter, Susan; Reed, Heath; Clarke, Zoë; Judge, Simon; Heron, Nicola; Mccarthy, Avril; Langley, Joe; Stanton, Andrew; Wells, Oliver; Squire, Gill; Quinn, Ann; Strong, Mark; Shaw, Pamela J; Mcdermott, Christopher J

    2016-01-01

    Current practice and guidelines recommend the use of neck orthoses for people with amyotrophic lateral sclerosis (ALS) to compensate for neck weakness and to provide surrogate neck control. However, available options are frequently described by patients as restrictive and unsuitable and there was a need for a new device that addressed the needs of people with ALS. This project utilized a co-design process to develop a new neck orthosis that was more flexible yet supportive. Following development of a prototype device, a mixed methods cohort study was undertaken with patients and carers, in order to evaluate the new orthosis. Twenty-six patients were recruited to the study, with 20 of these completing all phases of data collection. Participants described the impact of neck weakness on their life and limitations of existing supports. Evaluation of the new orthosis identified key beneficial features: notably, increased support while providing a greater range of movement, flexibility of use, and improved appearance and comfort. In conclusion, the results of this evaluation highlight the value of this alternative option for people with ALS, and potentially other patient groups who require a neck orthosis.

  15. Clinical application of a selected neck dissection through a low-collar incision in thyroid carcinoma%颈部低位领式切口行甲状腺癌择区性颈清扫的临床应用

    Institute of Scientific and Technical Information of China (English)

    刘军; 苏磊; 桑剑锋; 庄晓明; 姚永忠

    2015-01-01

    Objective:To generalize clinical application of a selected neck dissection through a low-collar incision in papillary thyroid carcinoma(PTC).Methods: We retrospectively analyzed clinical-pathology data of 160 PTC cases who underwent total thyroidectomy with a selected neck dissection through a low-collar incision and 42 PTC cases who underwent functional cervical dissection through L-form incision in our department from January, 2009 to September, 2014.Results:In 202 cases, metastatic rate of lymph node in neck central area was 71.3%while the lateral compartment was 54.5% and skipping metastasis was 5.94%.Smaller incision, shorter surgery time, minimal trauma, more cosmetic were the advantages of a selected neck dissection through a low-collar incision, but the results showed no differences in total hospitalization period, incidence of common complications, number of dissected lymph nodes and recurrence rate( P>0.05) .The lateral compartment lymph nodes metastasis was related to sex,age,neck central area metastasis,capsular invasion,maximal diameter and mulifocality in two groups(P<0.05 ) .Conclusion: In thyroid carcinoma patients with clinically suspicious or radiographic suggested lateral cervical lymph node metastasis, especially for the cN0 patients who were male younger than 45 years old, larger or equal to 2.0 centimeter in max ultrasound diameter, neck central area metastasis, mulifocality or capsular invasion,it is suggested to take lateral compartment lymph nodes dissection.If the patients had no extensive cervical lymph node metastasis( level Ⅱ b and Ⅴ a) and invasion,a selective cervical node dissection through a low-collar incision is a safe and reasonable choice.%目的:总结颈部低位领式切口行甲状腺癌择区性颈清扫的临床应用。方法:搜集2009年1月至2014年9月在我科行低位领式切口下甲状腺全叶切除术加择区性颈淋巴结清扫术的160例甲状腺乳头状癌患者及同期在“L”形切口下

  16. The immediate effect of kinesiology taping on muscular imbalance in the lateral flexors of the neck in infants: a randomized masked study.

    Science.gov (United States)

    Öhman, Anna

    2015-05-01

    To investigate the immediate effect of kinesiology taping (KT) on muscular imbalance in the lateral flexors of the neck. Randomized controlled trial. Twenty-nine infants with congenital muscular torticollis and muscular imbalance in the lateral flexors of the neck were chosen consecutively. In addition, 5 healthy infants with no signs of muscular imbalance in the neck were tested. The infants were randomly allocated to either an intervention group or a control group. The intervention group had kinesiology taping applied on the affected side using the muscle-relaxing technique. The healthy infants were tested both with and without kinesiology taping. The evaluator was blinded to whether the infants were or were not taped. There was a significant difference in the change of Muscle Function Scale (MFS) scores between the groups (P kinesiology tape was applied. For infants with congenital muscular torticollis, kinesiology taping applied on the affected side had an immediate effect on the MFS scores for the muscular imbalance in the lateral flexors of the neck. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. Indications and extent of elective neck dissection in patients with early stage oral and oropharyngeal carcinoma: nationwide survey in The Netherlands

    NARCIS (Netherlands)

    de Bree, R.; van der Waal, I.; Doornaert, P.; Werner, J.A.; Castelijns, J.A.; Leemans, C.R.

    2009-01-01

    Background: Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck. Material and methods: In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head

  18. 腹腔镜低位直肠癌经腹会阴联合切除并侧方淋巴结清扫术%Laparoscopic surgery for low rectal cancer with lateral lymph node dissection

    Institute of Scientific and Technical Information of China (English)

    王自强; 周总光

    2015-01-01

    手术采用5孔法,按日本学组提出的3间隙原则进行,TME手术完成第一间隙完整切除后,保护下腹神经丛及下腹神经,清扫其与髂总动脉、髂内动脉之间的第二间隙淋巴结,以及髂内外动脉间闭孔内的第三间隙淋巴脂肪组织。可视肿瘤部位、肿瘤浸润深度以及侧方淋巴结肿大情况,选择性行单侧或双侧的侧方淋巴结清扫。%Although long-term benefit of routine lateral lymph node dissection has not been proved by RCT, retrospective studies have shown its efficacy in lowering local recurrence and increasing survival rate in patients with lateral lymph node metastasis .The latest version of Japanese guidelines for the treatment of colorectal cancer still recommend lateral lymph node dissection , which is indicated when the lower border of the tumor is located distal to the peritoneal reflection and has invaded beyond the muscularis propria .Five ports were used for the laparoscopic procedure of lateral lymph node dissection .Three space dissections were performed, firstly total mesorectum excision , secondly dissection of lymph node between superior hypogastric plexus/hypogastric nerve and common/internal iliac arteries with preservation of autonerve , and lastly lymph node in the obturator formamen .One side or two sides lymph node dissection was performed according to the circumferential location of the tumor , the depth of tumor invasion and lateral lymph node status .

  19. Outcome of patients with early stage oral cancer managed by an observation strategy towards the N0 neck using ultrasound guided fine needle aspiration cytology: No survival difference as compared to elective neck dissection

    NARCIS (Netherlands)

    Flach, G.B.; Tenhagen, M.; de Bree, R.; Brakenhoff, R.H.; van der Waal, I.; Bloemena, E.; Kuik, D.J.; Castelijns, J.A.; Leemans, C.R.

    2013-01-01

    Objectives Management of the clinically N0 neck in oral cancer patients remains controversial. We describe the outcome of patients with T1-T2 oral cancer and N0 neck based on ultrasound guided fine needle aspiration cytology (USgFNAC) who were treated by transoral excision and followed by a ‘wait an

  20. Salvage central neck dissection for papillary thyroid cancer%补救性中央区淋巴清扫术在甲状腺乳头状癌中的应用

    Institute of Scientific and Technical Information of China (English)

    于文斌; 宋韫韬; 张乃嵩

    2012-01-01

    目的 探讨甲状腺乳头状癌中央区淋巴结可疑残留的补救治疗策略.方法 回顾性分析2006年1月至2009年1月行补救性中央区淋巴清扫术且临床随访资料完整的甲状腺乳头状癌患者85例.结果 补救性中央区淋巴清扫术后59例患者有阳性淋巴结,总的淋巴转移率为69.4%(59/85).59例共清扫336枚淋巴结,平均5.7枚;共有159枚转移淋巴结,每例平均2.7枚.外院记录已行清扫的6例患者补救手术后4例病理结果有淋巴转移,其中2例残留淋巴结位于头臂动脉与气管相交处,1例位于喉返神经的深面,1例位于气管前胸腺内.本组并发症发生率为10.6%(9/85),其中5例出现声嘶,其中2例患者发生暂时性甲状旁腺功能低下,术后出血1例,颈阔肌皮瓣下积液1例.随访3~5年,随访中位时间44个月,对侧中央区复发1例,侧颈复发4例,1例患者出现肺转移,全组无死亡病例.结论 对于未行中央区淋巴清扫但转移风险高(T3、T4级,原发灶被膜外侵犯,原发灶考虑肿瘤残留,血管或淋巴管侵犯)或在影像学下发现可疑转移淋巴结的病例,以及对于已行中央区清扫但考虑清扫范围不足、残留可能性大,或者未行中央区清扫,但术后病理发现阳性淋巴结的病例,须行补救中央区清扫手术.%Objective To evaluate the salvage central neck dissection (CND) for papillary thyroid cancer in the patients with suspicious residual positive lymph nodes in the central compartment.Methods A total of 85 cases undergoing salvage CND between January 2006 to Janurary 2009 was reviewed.Results Fifty-nine (69.4%) of the 85 patients showed residual positive lymph nodes in the central compartments.The number of dissected lymph nodes for each dissection ranged 2 - 13 nodes,with an average of 5.7 nodes.A total of 159 positive lymph nodes were found in the 59 cases,with an average of 2.7 positive nodes in each case.Four of 6 patients who underwent initial CND in

  1. Nerve damage during the neck dissection for thyroid cancer: causes and prevention%甲状腺癌颈淋巴结清扫术中神经损伤原因及预防

    Institute of Scientific and Technical Information of China (English)

    吴毅

    2012-01-01

    颈淋巴结清扫术是甲状腺癌治疗的一个重要组成部分,手术范围内有诸多的神经组织,主要有交感神经、迷走神经、副神经、舌下神经、面神经下颌缘支、膈神经及臂丛神经.颈淋巴结清扫术应由熟悉颈部解剖且具有一定手术技巧的医师来完成.颈部主要神经的损伤均会给病人带来相应的功能损伤,有时甚至影响病人一生的生存质量,所以术者一定要认真对待每一例病人.%Neck dissection is the essential part of the treatment of thyroid cancer. There are a lot of nerves involved in the procedure, for example, the sympathetic nerve, vagus nerve, accessory nerve, subglossal nerve, the marginal mandibular branch of facial nerve, phrenic nerve and brachial plexus. The physician performing the surgery is supposed to be very skillful and very acquainted with the neck anatomy. The damage of the nerve will cause the corresponding damage of the body funtion, and therefore affect the quality of life in a certain level. In conclusion, each of the candidate for neck dissection should be handled seriously.

  2. Neck x-ray

    Science.gov (United States)

    X-ray - neck; Cervical spine x-ray; Lateral neck x-ray ... There is low radiation exposure. X-rays are monitored so that the lowest amount of radiation is used to produce the image. Pregnant women and ...

  3. 中央区淋巴结清扫在分化型甲状腺癌治疗中的必要性探讨%The study on central neck dissection for differentiated thyroid cancer

    Institute of Scientific and Technical Information of China (English)

    蔡伟; 罗斌; 海涛; 王亚军; 康骅

    2013-01-01

    Objective To evaluate the role of central neck dissection(CND) in patients with differentiated thyroid cancer(DTC).Methods All 125 patients were diagnosed as DTC by pre-operative or intraoperative pathology.The thyroid foci were treated with total thyroidectomy(TT) or ipsilateral lobectomy plus isthmusectomy and contralateral near-total lobectomy(LIN),and CND was performed in all patients at the same time.If there were suspension or evidence of the lateral lymph node metastasis preoperatively or intraoperatively,the lateral neck dissection would be done.Results The rate of central lymph node metastasis(CLNM) was 57.6% (72/125),and skip metastasis was found in five patients.Gender(P =0.705),side(P =0.504),extrathyroidal extension(P =0.086) did not correlate with the rate of CLNM.The patients of less than 45 years and with non-minimum cancer had significantly higher rate of CLNM than those of greater than or equal 45 years (P =0.002) and with minimum cancer (P =0.000) respectively.Of 57 cN0 patients,25 patients had CLNM pathologically (43.8%).The rate of temporary hypoparathyroidism and recurrent laryngeal nerve injury in TT group(29.1%)was significant higher(P =0.000),compared with that of LIN group(10%).Conclusion The patients with DTC have much high rate of CLNM.CND can remove the occult lymph node metastasis and reach radical cure of thyroid cancer,and guide the treatment after operation by more precise pathology staging.Therfore,the routine CND is suggested in patient with DTC.%目的 探讨分化型甲状腺癌手术中行中央区淋巴结清扫的临床意义.方法 术前或术中病理确诊为分化型甲状腺癌125例,手术方式为甲状腺全切或患侧全切+峡部+对侧近全切除术,同时加行颈中央区淋巴结清扫术;如术前、术中怀疑或明确颈侧区淋巴结转移时,则进一步行颈侧区淋巴结清扫.结果 中央区(Ⅵ区)淋巴结转移发生率为57.6% (72/125),5例发生跳跃性转移.中央区

  4. The Effect of Dry Needling on Range of Motion of Neck Lateral Flexion in Subjects With Active Trigger Point in Upper Trapezius Muscle

    Directory of Open Access Journals (Sweden)

    Ziaeifar

    2014-12-01

    Full Text Available Background Myofascial trigger point is one of the most common causes of musculoskeletal disorders. Myofascial trigger point in upper trapezius has been reported as a symptom in patients with neck and upper thoracic pain. Objectives The purpose of this study was to investigate the effect of dry needling compared with ischemic pressure on trigger point in upper trapezius muscle. Materials and Methods 28 subjects with myofascial trigger point in upper trapezius participated in this study. The subjects were randomly assigned to two groups: dry needling (n = 13 and ischemic pressure (n = 15. The neck lateral flexion range of motion was measured before and after treatment in both groups using a standard goniometer. Paired t-test was used to determine any significant difference in range of motion after treatment sessions compared with pre-treatment score in control and experimental group. Analysis of Covariance (ANCOVA was calculated to determine the significance of differences between the control and experimental groups in post-test scores, with pre-treatment scores used as covariates in the analysis. Results Statistical analysis (paired t-test revealed significant increase in neck lateral flexion range of motion in contra-lateral side after treatment sessions in control and experimental group compared with pre-treatment score (P < 0.05. However, only dry needling was effective in increase of range of motion in Ipsi-lateral side (P = 0.001. In the ANCOVA, controlling for pre-test scores, no significant difference was found between the two groups in the after treatment sessions (P = 0.06 and (P = 0.15. Conclusions The application of DN produces an improvement in ILF and CLF can be prescribed for subjects with MTP in UT muscles.

  5. PEMBERIAN TEKNIK MULLIGAN DAN SOFT TISSUE MOBILIZATION LEBIH BAIK DARIPADA HANYA SOFT TISSUE MOBILIZATION DALAM MENINGKATKAN LINGKUP GERAK SENDI EKSTENSI, ROTASI, LATERAL FLEKSI CERVICAL PADA MECHANICAL NECK PAIN

    Directory of Open Access Journals (Sweden)

    sudaryanto -

    2013-11-01

    Full Text Available Mechanical neck pain has the same high prevalence with low back pain, and commonly found in many of physiotherapy practice. Combination of Mulligan technique and Soft Tissue Mobilization are one of manual therapy technique highly effective and efficient to care the case of mechanical neck pain but still very rarely used by physiotherapist in fields of practice. This study aimed to know the effectiveness between Mulligan technique – Soft Tissue Mobilization and only Soft Tissue Mobilization to the increasing range of motion extension, rotation and side flexion cervical on the mechanical neck pain. The study design was a pre test – post test control group design using two group of samples are control groups that given intervention Soft Tissue Mobilization and treatment groups that given a combination of Mulligan technique and Soft Tissue Mobilization. Measuring instrument used for data collection was goniometer, that the goniometer was used to measure the range of motion extension, rotation and lateral flexion of the cervical either before the intervention and after the intervention. Sample of this study was 32 people who divided into 2 groups of samples were 16 people in the control group and 16 people in the treatment group. Samples in the control group had a mean age of 35,69 with male of 7 people (43,8% and female of 9 people (56,2% as well as limitations of the right direction were 12 people (75% and left direction were 4 people (25%. Whereas in the treatment group had e mean age of 35,94 with male of 10 people (62,5% and female of 6 people (37,5% as well as limitations of the right direction were 11 people (62,5% and left direction were 5 people (31,2%. The results of hypothesis testing using independent sampel t-test showed a significant difference between the mean post-intervention ROM extension, rotation, lateral flexion of the control groups and the mean post-intervention ROM extension, rotation, lateral flexion of the treatment

  6. The outcome analysis on shoulder function after neck dissection with preservation of the deep branch of the cervical plexus%保留颈丛神经深支的颈清扫术后肩功能评估

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的探讨颈清扫术中颈丛神经深支保留对术后肩功能的影响。方法37例头颈部恶性肿瘤患者接受不同颈清扫术式,17例保留副神经及颈丛C2-C4深支(A组),11例切除副神经、保留颈丛C2-C4深支(B组),9例切除副神经及颈丛C2-C4深支(C组)。术后6个月就肩关节功能障碍指数(SPADI)、肩关节活动度进行比较,术后6周及6个月就斜方肌肌电图进行比较。结果 SPADI及肩关节活动度A组恢复最好,B组次之,C组最差,三组间两两比较均有统计学差异。术后6周A组斜方肌三部分肌电活动均较强,B组上部活动较强,与A组比较无明显差异,中、下部较A组差;术后6月A组斜方肌三部分肌电均优于B组,C组术后6周及6月均未引出肌电活动。结论颈清扫术中酌情保留颈丛神经深支,可以减少传统手术后肩功能障碍发生的机率和程度,提高患者术后生活质量。%Objective To investigate the relation during preservation of the deep branch of the cervical plexus and shoulder function after neck dissection. Methods Thirty seven patients who had undergone different neck dissections were enrolled and divided into 3 groups. Seventeen patients preserved both accessory nerve and the cervical branches, 11 preserved cervical branches, and 9 sacrificed both of them. Shoulder pain and disability scores (SPADI) and Goniometric measurements were detected at the sixth postoperative month. The distal motor latency of the nerve with sEMG to detect electromyographic activity of the trapezius muscle was conducted at the sixth week and sixth month postoperatively among the three groups. Results The patients in group A whose accessory nerves and cervical branches were preserved had a significant functional rehabilitation of the shoulder, while those who preserved only the cervical branches in group B had a better result than the radical neck dissection in group C after 6 months of

  7. Esvaziamento radical versus seletivo (supraomohióideo no tratamento do carcinoma epidermóide do andar inferior da boca Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth

    Directory of Open Access Journals (Sweden)

    Abrão Rapoport

    2007-10-01

    Full Text Available O paradigma terapêutico para o CEC do andar inferior da boca sofreu modificações em decorrência da sobrevida. OBJETIVO: Estudo comparativo do esvaziamento cervical radical e seletivo. MATERIAL E MÉTODO: Análise de 460 pacientes atendidos no Depto. de CCP e ORL do Hospital Heliópolis, de 1978 a 2002. Para esvaziamento radical foram avaliados os padrões de metastatização dos níveis IV e V, para o seletivo a ocorrência e localização das recidivas. O método estatístico utilizado foi o teste do qui-quadrado. RESULTADOS: Nos esvaziamentos radicais a taxa de metastatização nos níveis IV e V foram 5,8% e 4,6%, nos pacientes cNO e de 9,9% (nível IV e 5,9% (nível V para cN+, enquanto o nível I isolado estava comprometido em 11,0% nos cN0 e 5,5% nos cN+. Nos esvaziamentos seletivos ocorreram 4 recidivas (4,1% em 97 esvaziamentos nos pN0 e 2 (10,0% em 20 esvaziamentos. Nos casos pN+, não houve vantagens na indicação de radioterapia sobre os não irradiados (5,6% e 5,7% respectivamente. CONCLUSÃO: É possível realizar esvaziamento seletivo no tratamento das metástases do andar inferior de boca.The therapeutic paradigm for neck metastasis of squamous cell carcinoma (SCC in the lower level of the mouth has changed due to survival. AIM: A comparative study between radical (RND versus selective neck dissection (SND. MATERIAL AND METHOD: An analysis of mouth SCC in the lower level of the mouth in 460 files from the Head & Neck and ORL Department of the Heliopolis Hospital, from 1978 to 2002. In the RND the metastathic rate in levels IV and V was assessed; in the SND the presence and site of recurrence was identified. The chi square test with the Yates correction was the chosen statistical method. RESULTS: In the RND the metastatic rates were 5.8% (level IV and 4.6% (level V for cNO cases, and 9.9% (level IV and 5.9%(level V for cN+ cases; for level I only the rates were 11,0% for cNO cases and 5.5% for cN+ cases. In the SND the number

  8. [Late neck metastasis in esthesioneuroblastoma: a case report].

    Science.gov (United States)

    Damar, Murat; Başerer, Nermin; Ozkara, Selvinaz; Yılmazer, Rasim

    2012-01-01

    Esthesioneuroblastoma is a rare malignancy of olfactory neuroepithelium arising from sinonasal region. It has biologically an aggressive behavior. The tumor is characterised by common local recurrence, atypic distant metastasis and poor long-term prognosis. Cervical metastasis accounts for 20-30% of the patients. Late metastases are seen particularly six months or later following primary treatment. In this article, we present a 43-year-old female case with Kadish B stage esthesioneuroblastoma who underwent extracranial tumor resection and postoperative radiotherapy. Eleven years later (at 132 months) right neck cervical metastasis was occurred and we applied right functional neck dissection and adjuvant radiotherapy to treat. We also review the treatment of late neck metastasis in the light of the current literature data.

  9. 不同负压引流方式在颈淋巴清扫术后的护理研究%Nursing study of different negative pressure drainage method after neck dissection

    Institute of Scientific and Technical Information of China (English)

    王晓艳; 谷小萍

    2015-01-01

    Objective To explore the application effect of different negative pressure drainage bottle in nursing care of patients received neck dissection .Methods From January 2012 to December 2014, 17 in 29 cases of neck dissection surgery patients adopted vacuum high negative pressure drainage bottle , through the observation of postoperative drainage fluid status and postoperative hemorrhage , infection of incision , drainage time, average nursing operation time , pain scores and satisfaction score , to observe the differences between each other.Results There were no differences between two different negative pressure drainage groups on postoperative hemorrhage , drainage time , wound infection and salivary fistula .Average nursing operation time , pain score and the score of satisfaction were different .Conclusions High vacuum negative pressure drainage bottle can reduce average nursing operation time and pain scores , improve satisfaction score .%目的:探讨不同负压引流瓶在颈淋巴清扫手术后护理中运用的效果。方法对2012年1月至2014年12月期间29例颈淋巴清扫手术患者中的17例采用高真空负压引流瓶,通过观察术后不同引流方式患者引流液状况及术后出血、切口感染、引流时间、疼痛评分、满意度评分等指标,对比普通负压引流球,观察其相互差异。结果使用高真空负压引流瓶组的患者术后引流时间、出血、切口感染、涎漏发生率无差别,均次护理操作时间、疼痛评分、满意度评分有差别。结论使用高真空负压引流瓶组和普通负压球的患者术后引流时间、出血、切口感染、涎漏发生率等方面均无显著差异,但均次护理操作时间、疼痛评分、满意度评分较普通组有明显改善。

  10. SUCCESSFUL ANAESTHETIC MANAGEMENT OF A PATIENT WITH PARADOXICAL VENTRICULAR SEPTAL MOTION (PVSM POSTED FOR MODIFIED RADICAL NECK DISSECTION WITH RADIAL FREE FLAP

    Directory of Open Access Journals (Sweden)

    Amruta

    2015-04-01

    Full Text Available BACKGROUND : Patients with paradoxical ventricular septal motion are a challenge to anaesthesiologist due to risk of perioperative myocardial ischaemia and sudden cardiac arrest. CASE DESCRIPTION : We present anaesthetic management of a 45year old lady with a diagnosed case of carcinoma left buccal mucosa with paradoxical ventricular septal motion posted for modified radical neck disse ction with radial free flap. CONCLUSION : Although clinical manifestations of this cardiac condition may be mild, there is certainly associated pathology of direct relevance, which carries importance in the anaesthetic management in the peri - operative perio d. Patients with paradoxical ventricular septal motion of any etiology are more prone for perioperative myocardial ischaemia and sudden cardiac arrest, because if cardiac conduction is not maintained properly then it may result in further increase in the p aradoxical ventricular septal motion

  11. Cervical artery dissection following a turbulent flight.

    LENUS (Irish Health Repository)

    Quinn, Colin

    2012-01-31

    BACKGROUND: Cervical artery dissection is a common cause of stroke in young patients without vascular risk factors and may affect the carotid or vertebral arteries. The risk of spontaneous dissection is higher in those with genetic predisposing factors while other cases may be precipitated by an event involving head or neck movement or associated with direct neck trauma. CASE REPORT: We present the case of a previously well young woman with a history of migraine who developed internal carotid artery dissection following a turbulent short-haul commercial flight while restrained using a seatbelt. DISCUSSION: We propose that repetitive flexion-hyperextension neck movements encountered during the flight were the most likely precipitant of carotid artery dissection in this case and review the therapeutic options available.

  12. PET-CT–Guided Surveillance of Head and Neck Cancers

    Science.gov (United States)

    Patients with advanced squamous cell carcinoma of the head and neck who underwent PET-CT–guided surveillance had fewer operations but similar overall survival rates to those of patients who underwent planned neck dissection.

  13. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    Science.gov (United States)

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

  14. N0、N1期口腔癌颈淋巴结清扫术式回顾分析%NECK DISSECTION IN PATIENTS WITH ORAL SQUAMOUS CELL CARCINOMA IN N0 OR N1 STAGE:A RETROSPECTIVE CLINICAL ANALYSIS

    Institute of Scientific and Technical Information of China (English)

    商洪涛; 周宏志; 顾晓明

    2001-01-01

    To evaluate the incidence of sub-clinical neck metastasis and its surgical treatment in patients with oral squamous cell carcinoma (OSCC) without clear evidences for lymph nodes metastasis, a total of 205 patients with OSCC in N0 and N1 stage(UICC 1987′s classification) were included in the study.Their clinical and histopathological files were retrospectively studied and patients were followed up after operation. Histopathological positive lymph nodes were found in 10.8%(13/120) of patients,and postoperative lymph nodes metastasis occurred in 16.5%(14/85) of patients without neck dissections.There were no significant differences between N0 and N1 groups.Neck recurrence occurred in 11.9%(5/42) of patients after functional neck dissections.The rate was higher in patients with bucal lesions.Patients undergoing radical neck dissections also had neck recurrence with an incidence of 6.4%.But most of them occurred on contralateral side. It suggested that subclinical metastasis of OSCC with clinically negative neck lymph nodes could not be neglected.Functional neck dissection should include the lymph nodes of level Ⅲ,especially for cancers located on bucca mucosa and tongue.Bilateral neck dissection is necessary for large primary lesions spreading to the contralateral side.%通过回顾性分析探讨无明确临床转移指征的口腔鳞状细胞癌发生亚临床颈部淋巴结转移的概率及其外科处理的较好术式。根据UICC(1987年)分类分期标准,回顾205例淋巴结分期为N0、N1期的口腔癌病例的临床病理资料,术后随访,了解此类病例发生颈部淋巴结转移的概率以及不同手术方式处理后颈部淋巴结的转归。结果发现,转移淋巴结病理检出率为10.8%(13/120),而不作颈清扫术后淋巴结转移率为16.5%(14/85),N0、N1期无显著差别;功能性颈清扫术后淋巴结复发率达11.9%(5/42),其中颊癌的复发发生率较高;根

  15. Acute headache and persistent headache attributed to cervical artery dissection

    DEFF Research Database (Denmark)

    Schytz, Henrik W; Ashina, Messoud; Magyari, Melinda

    2014-01-01

    The criteria for headache attributed to cervical artery dissection have been changed in the new third edition of the International Classification of Headache Disorders (ICHD-III beta). We have retrospectively investigated 19 patients diagnosed from 2001 to 2006 with cervical artery dissection...... at onset and followed them up six months after dissection. At dissection onset 17/19 patients were classified as headache probably attributed to vascular disorder at the time of dissection using the ICHD second edition (ICHD-II) criteria. In contrast, 17/19 of patients fulfilled the ICHD-III beta criteria...... for Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection or Headache attributed to intracranial arterial dissection. Six months after dissection five of 19 patients still reported persistent headache attributed to dissection. The study demonstrates that the ICHD...

  16. Environmental factors and cervical artery dissection.

    Science.gov (United States)

    Caso, Valeria; Paciaroni, Maurizio; Bogousslavsky, Julien

    2005-01-01

    A history of a minor precipitating event is frequently elicited in patients with a spontaneous dissection of the carotid or vertebral artery. Other precipitating events associated with hyperextension or rotation of the neck include practicing yoga, painting a ceiling, coughing, vomiting, sneezing, the receipt of anesthesia, and the act of resuscitation. Chiropractic manipulation of the neck has been associated with carotid artery dissection and, particularly, vertebral artery dissection. Another risk factor for spontaneous dissections seems to be a recent history of a respiratory tract infection. The possibility of an infectious trigger is supported by the finding of a seasonal variation in the incidence of spontaneous dissections, with a peak incidence in fall. A potential link with common risk factors for vascular disease, such as tobacco use, hypertension, and the use of oral contraceptives, has not been systematically evaluated, but atherosclerosis appears to be distinctly uncommon in patients with a dissection of the carotid or vertebral arteries. In conclusion, although any hypotheses on the pathogenic mechanisms linking environmental factors and dissection remain speculative at present, we believe that these hypotheses may contribute to better define the spectrum of pathogenic conditions predisposing a cervical artery to dissection and provide arguments to better investigate the single or combined effect of such susceptibility factors in future studies.

  17. An interesting case report of vertebral artery dissection following polytrauma

    Directory of Open Access Journals (Sweden)

    Vikas Acharya

    2016-01-01

    Conclusion: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

  18. Isolated neck-lifting procedure: isolated stork lift.

    Science.gov (United States)

    Barbarino, Sheila C; Wu, Allan Y; Morrow, David M

    2013-04-01

    along the mastoid and posterior hairline to the midline nape of the neck. Long skin flaps were developed by dissecting the anterior neck from the mentum to the anterior clavicles, the lateral neck from the mastoid to the lateral clavicles, and the posterior neck from the hairline to the base of the nape of the neck, all with a combination of sharp and blunt dissection. Suspension sutures of the SMAS were placed at various strategic locations along the lateral neck in a superior posterior vector. The dog ears were walked posteriorly around the hairline, with final trimming at the midline nape using an A-to-T flap closure. The skin closure was affected by a combination of deep and superficial sutures as well as staples. No drains were used on any of the cases. Of the 273 patients (59 males and 214 females) who had the ISL, 240 rated their satisfaction with the results as very high, 21 rated it as high, and 12 rated it as some what satisfied. The average age of the patients was 58.7 years (range=45-79 years). There were two patients who needed a minimal amount of submental liposuction after the procedure. No patients had vertical/diagonal skin folds after this procedure. Five patients reported being slightly bothered by the appearance of the midline posterior scar for the first 6 months. Three of these cases involved hypertrophic scarring and were treated with intralesional triamcinolone suspension 40 mg per cc dilution; doses ranged from 20 to 40 mg per session and no more than two sessions were required. All five cases rated their scar appearance after 6 months to be acceptable. All of the remaining 268 patients reported that the final posterior scar was virtually undetectable. Ten patients needed scar revision for secondary widening of the scar at various locations of the lateral, posterior, and or nape of the neck. There were no other significant complications. Most patients were satisfied with their cosmetic result 2 years after their operation. An ISL procedure

  19. Quantification of lymph nodes in the central compartment of the neck: a cadaveric study.

    Science.gov (United States)

    Ofo, Enyinnaya; Thavaraj, Selvam; Cope, Daron; Barr, James; Kapoor, Karan; Jeannon, Jean-Pierre; Oakley, Richard; Lock, Claire; Odell, Edward; Simo, Ricard

    2016-09-01

    Differentiated thyroid cancer (DTC) accounts for over 90 % of thyroid malignancies, and is frequently associated with central neck compartment nodal metastasis that requires a therapeutic central compartment neck dissection (CCND) for clinically evident nodes. Current knowledge on the expected lymph node yield from a CCND is limited, compared with data on the lateral neck. The aim of our study was to accurately quantify nodal yield from the cadaveric central neck compartment. Twenty-eight cadaveric necks were dissected and the central neck compartment was subdivided into four regions: pre-laryngeal (delphian), pre-tracheal, right and left para-tracheal regions. Each cadaver had a thyroid gland, which was also removed, and the CCND tissue in each compartment was processed and examined by a consultant histopathologist. Only lymphoid tissue with a defined microscopic fibrous capsule and subcapsular sinus was included in the node count. The median total lymph node count per cadaver was four (range 1-16), with a median of one node detectable in each para-tracheal region (range 0-7) and the pre-tracheal region (range 0-8). The median pre-laryngeal node count was 0 (range 0- 2). The average lymph node size across all compartments was 2.9 mm. This is the first European study to assess cadaveric central neck lymph nodes and establish baseline counts for nodal yield. If a prophylactic or therapeutic CCND is required during thyroid surgery, those involved in DTC management must recognise that there is a wide range, and low median yield of central neck compartment lymph nodes.

  20. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

    NARCIS (Netherlands)

    Coskun, H.H.; Medina, J.E.; Robbins, K.T.; Silver, C.E.; Strojan, P.; Teymoortash, A.; Pellitteri, P.K.; Rodrigo, J.P.; Stoeckli, S.J.; Shaha, A.R.; Suarez, C.; Hartl, D.M.; Bree, R. de; Takes, R.P.; Hamoir, M.; Pitman, K.T.; Rinaldo, A.; Ferlito, A.

    2015-01-01

    Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore,

  1. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

    Full Text Available Abstract Background Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects. Methods This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection. Results There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved. Conclusion The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.

  2. Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

    LENUS (Irish Health Repository)

    Edmundson, S P

    2012-01-31

    We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

  3. 领式切口保留颈丛择区性颈部淋巴结清扫术治疗分化型甲状腺癌112例分析%Preservation of the cervical plexus with a selective neck dissection through a low-collar incision in patients with differentiated thyroid carcinoma: an analysis of 112cases

    Institute of Scientific and Technical Information of China (English)

    孙团起; 吴毅

    2011-01-01

    Objective To determine the utility and experiences of preserving the cervical plexus in selective neck dissections for differentiated thyroid carcinoma (DTC). Methods Preservation of the cervical plexus was used for selective neck dissection through a low-collar incision in 112 cases of DTC from January 2009 to December 2010 in the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center. Results The most common site of cervical lymph node metastases was level Ⅵ (78.8%), followed by level Ⅳ (72.9%) and Ⅲ (60.2%). The metastasis rates in level Ⅱ and ⅤB were 43.8% and 16.9%, respectively. No impairment of sensation of ears, lower necks and upper shoulders was found. There was no local recurrence at the time of follow-up for 1 to 25 months. Conclusion If utilized in the appropriate patient population, a selective neck dissection through a low-collar incision for DTC can be a successful alternative to the modified or radical neck dissection. It could be performed in N1b patients when there is no level ⅤA lymph node metastasis, or when the metastasis is not aggressive.%目的 总结领式切口保留颈丛的择区性颈部淋巴结清扫术在分化型甲状腺癌中的应用和经验.方法 复旦大学附属肿瘤医院头颈外科2009年1月至2010年12月期间对112例临床考虑颈侧区转移(CN1b)甲状腺癌病人在原发灶根治的同时施行了领式切口保留颈丛的择区性颈部淋巴结清扫术.结果 颈部淋巴结转移主要分布在Ⅵ区(78.8%)、Ⅳ区(72.9%)、Ⅲ区(60.2%)、Ⅱ区(43.8%)和ⅤB区(16.9%).病人术后均无明显耳部、下颈部和肩部感觉异常.术后经1~25个月随访无局部复发.结论 对于临床考虑颈侧区转移(CN1b)或穿刺证实颈侧区转移的分化型甲状腺癌,在没有ⅤA区转移或没有淋巴结明显外侵的首次手术病人,领式切口保留颈丛的择区性颈清扫可以作为替代根治性或改良性颈清扫的一种选择.

  4. Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

    1987-06-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

  5. Developmental biomechanics of neck musculature.

    Science.gov (United States)

    Lavallee, Amy V; Ching, Randal P; Nuckley, David J

    2013-02-01

    Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A factorial study was performed on 91 human subjects measuring head-and-neck anthropometry and neck strength and endurance in three bending directions (flexion, extension, and lateral) as a function of age (6-23 years). Using a custom device, neck maximum voluntary contraction (MVC) force was measured in triplicate. Next, neck muscle endurance (sustained effort) was measured as the subjects' ability to maintain 70% of peak force over 30s. Linear regression of peak force and endurance as a function of age revealed each direction to significantly (pNeck muscle strength, similar between young males and females, becomes disparate in adolescence and adulthood with males exhibiting greater strength. Bending direction differences were also found with extension strength being the greatest regardless of age and sex. Furthermore, neck circumference appears predictive of neck strength and endurance in children. Together, these relationships may facilitate improved design of injury prevention interventions.

  6. Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca Prognostic significance of the number of lymph nodes in elective neck dissection for tongue and mouth floor cancers

    Directory of Open Access Journals (Sweden)

    Ali Amar

    2012-04-01

    Full Text Available A presença de linfonodos metastáticos é aspecto relevante no tratamento do câncer na cabeça e pescoço, resultando em 50% de redução na sobrevida. OBJETIVO: Avaliar o número de linfonodos removidos no esvaziamento cervical e sua relação com o prognóstico. MÉTODOS: Estudo retrospectivo de 143 pacientes portadores de carcinoma epidermoide de língua e soalho bucal, cujo exame histológico evidenciou ausência de metástases linfonodais. Desses, 119 eram masculinos e 24 femininos, com idade média de 54 anos. Quanto ao sítio do tumor primário, 65 eram na língua e 78 no soalho bucal. A distribuição do estádio T foi de quatro T1, 84 T2, 36 T3 e 19 T4. Foram realizados 176 esvaziamentos cervicais, sendo unilateral em 110 casos e bilateral em 33. Desses, 78 radicais e 98 seletivos. Os pacientes foram separados em três grupos, de acordo com os percentis 33 e 66 do número de linfonodos ressecados. RESULTADOS: O número médio de linfonodos ressecados foi de 27, sendo 24 nos esvaziamentos seletivos e 31 nos completos. Não foram observadas diferenças estatisticamente significantes quando relacionado aos estádios T e N. CONCLUSÕES: O maior número de linfonodos dissecados no esvaziamento cervical identifica um grupo de melhor prognóstico nos casos pN0.The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival. OBJECTIVE: To assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis. METHODS: A retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110

  7. 鼻咽癌放疗后残留和复发颈淋巴结清扫术的疗效和手术方式的选择%Neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma after radiotherapy:effect and choice

    Institute of Scientific and Technical Information of China (English)

    Liangping Xia; Zongyuan Zeng; Zhuming Guo; Guifang Guo; Bei Zhang; Huijuan Qiu; Feifei Zhou

    2009-01-01

    Objective:To investigate lhe best surgical mode for the patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy.Methods:The dinical data of 88 patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively.The levets of involved lymph nodes and the relationship among the levels were analyzed;the survival rate and recurrent rate of the surgical modes including radical neck dissection(RND),modified radical neck dissection(MRND),selective neck dissection(SND),and lymph node resection(LNR)were analyzed;the role of postoperative radiotherapy was evaluated.Results:(1)The recurrent and persistent lymph nodes mainly located in level Ⅱ(55.6%and 58.6%,respectively),next was level Ⅲ and rarely in level Ⅳ.Ⅴand Ⅰ,but the number of levels Ⅳ,Ⅴ and Ⅰ with cencer-bearing lymph nodes was relatively more tban that of clinical measurement.(2)Patients with lymph nodes involved in level Ⅲ and Ⅳ.usually,have other levels involved simultaneously;the percentages were 63.6%and 88.9%,respectively.However,the lymph nodes in level Ⅱ and Ⅴ were mainly isolated.(3)The 5-year survival rate and recur-rent rate of the whole group were 42.77%and 22.7%,respectively.(4)The 5-year survival rates of RND,MRND.SND,and LMR groups were 39.75%,60.00%,37.87%,and 44.10%,respectively;the differences were insignificant(Log-rank:1.0,P=0.8011):the recurrent rate between the extensive and local surgery groups were insignificant(X2=0.470,P=0.493).(5) The 5-year survival rates of the patients with and without postoperative radiotherapy were 39.06% and 45.26%.respectively;the difference was insignificant (Log-rank=0.06.P=0.8138).Conclusion:The extensive surgery was recommended when the recurrent and persistent lymph nodes were more than one level jnvolved or very large or immovable,otherwise,the SND should be performed and postoperative radiotherapy was important compensation if necessary.

  8. Application of functional neck dissection for lower collar-shaped incision at hair margin behind ear in the treat-ment of differentiated thyroid cancer%耳后发缘低领口状切口的功能性颈清术在分化型甲状腺癌中的应用

    Institute of Scientific and Technical Information of China (English)

    赵健洁; 张晓华; 高博; 姜燕; 文亚渊

    2015-01-01

    Objective To explore role of functional neck dissection for lower collar-shaped incision at hair margin behind ear in the treatment of differentiated thyroid cancer. Methods The clinical data of 11 patients with thyroid papillary carcinoma who underwent func-tional neck dissection for lower collar-shaped incision at hair margin behind ear were retrospectively analyzed. Results The incisions of all patients were unseen in daily life and patients were satisfied with the postoperative appearances. No case of shoulder syndrome,postoperative local recurrence and distant metastasis was observed. Conclusion Functional neck dissection for lower collar-shaped incision at hair margin behind ear is effective in the treatment of differentiated thyroid cancer. Meanwhile it can obviously improve patients’ postoperative appearance and life quality,therefore it is worth clinical application.%目的:探讨耳后发缘低领口状切口的功能性颈清术在分化型甲状腺癌治疗中的作用。方法回顾性分析我科11例甲状腺乳头状癌患者行耳后发缘切口的功能性颈清术治疗的临床资料。结果11例患者术后切口日常情况隐匿不可见,患者对术后外观满意度高,无肩综合征,术后无局部复发及远处转移。结论耳后发缘低领口状切口的功能性颈清术既能达到治疗目的,相较于传统功能性颈清术,能明显改善术后颈部外形,提高患者术后的生活质量,值得临床推广应用。

  9. Neck Pain

    Science.gov (United States)

    ... antidepressants for pain relief. Therapy Physical therapy. A physical therapist can teach you correct posture, alignment and neck- ... therapy, under supervision of a medical professional and physical therapist, may provide relief of some neck pain, especially ...

  10. 游离上臂外侧皮瓣在头颈部缺损中的应用进展%Clinical Progress of Lateral Arm Free Flap for Repairing after Resecting the Head and Neck Carcinoma

    Institute of Scientific and Technical Information of China (English)

    孙瑞梅; 隋军

    2012-01-01

    The lateral arm free flap(LAFF) is one of which cross the intermuscular septa fascia,it had been applied on surgical repair and reconstruction widely, and the flap is being tried to apply on reconstructing the defects of head and neck in recent years. It had been proved by clinical data that the lateral arm free flap was more superior than the fore arm free flap which was the classical flap to repair the defects of head and neck,for examples the donor-site of the flap was more hiddened,the flap did not destroy the arm major artery and it was more sensitive and so on. LAFF will be the ideal supplement of the fore arm free flap and another new choice to repair the defects of head and neck.%上臂外侧皮瓣(LAFF)属肌间隔筋膜穿支皮瓣,应用于手外科修复重建已十分成熟和广泛,近年来被尝试应用于头颈部缺损的修复重建.临床研究证明,该皮瓣与修复头颈部缺损的经典皮瓣--前臂皮瓣相比,具有皮瓣供区更隐蔽、不牺牲手臂的主供动脉以及皮瓣感觉功能更加良好等优点.LAFF可成为前臂皮瓣的理想补充和修复头颈部缺损的又一新选择.

  11. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  12. Neck pain

    OpenAIRE

    2002-01-01

    Non-specific neck pain has a postural or mechanical basis, and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but becomes chronic in about 10% of people.Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident.

  13. Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

    Directory of Open Access Journals (Sweden)

    Deniz Kamacı Şener

    2012-12-01

    Full Text Available Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

  14. Aortic dissection (image)

    Science.gov (United States)

    Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the ... the inner wall of the artery. Although aortic dissection can affect anybody, it is most often seen ...

  15. Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach.

    Science.gov (United States)

    Dan, Tu D; Raben, David; Schneider, Charles J; Hockstein, Neil G; Witt, Robert L; Dzeda, Michael; Cormier, Jennifer F; Raben, Adam

    2015-06-01

    To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated. Median follow up was 37.2months (range 4-121months). Freedom from contralateral nodal failure at 5years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5year disease-free survival (DFS) was 86.7%. This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Neck lump

    Science.gov (United States)

    ... the neck lump treated. When to Contact a Medical Professional Call your health care provider if you have an abnormal neck swelling or ... to Expect at Your Office Visit The health care provider will take your medical history and do a physical exam. You may ...

  17. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection

    NARCIS (Netherlands)

    Rodrigo, J.P.; Shah, J.P.; Silver, C.E.; Medina, J.E.; Takes, R.P.; Robbins, K.T.; Rinaldo, A.; Werner, J.A.; Ferlito, A.

    2011-01-01

    The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this

  18. Malakoplakia of the neck.

    Science.gov (United States)

    Schmerber, Sebastien; Lantuejoul, Sylvie; Lavieille, Jean-Pierre; Reyt, Emile

    2003-11-01

    Malakoplakia that presents in the head and neck is very rare. We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia. To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck. Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host. The symptoms are nonspecific and the diagnosis is based on the histologic findings. In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia. Bacteriologic analysis identified Escherichia coli. The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.

  19. Severe orthostatic hypotension due to unilateral carotid artery dissection

    Directory of Open Access Journals (Sweden)

    Nobuyuki Ishii

    2014-06-01

    Full Text Available A 46-year-old woman was admitted to our hospital with mild right-sided hemiparesis and orthostatic hypotension. Magnetic resonance angiography of the neck showed stenosis of the left distal carotid sinus surrounded by intraluminal hyperintensities on both T1-weighted and T2-weighted images, representing a periluminal hematoma secondary to carotid artery dissection. The dissection hyperextended the carotid artery wall and stimulated baroreceptors in the carotid sinus. The stimulated baroreceptors induced carotid sinus hypersensitivity, which may have been related to her orthostatic hypotension. Post-stroke orthostatic hypotension should prompt consideration of carotid artery dissection.

  20. Bilateral synchronous parathyroids cancer and femoral neck fracture as the complications of tertiary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    A F Romanchishen

    2013-12-01

    Full Text Available In the paper has presented the first in Russia observation of bilateral synchronous parathyroids cancer in patient with urolithiasis complicated by chronic pyelonephritis, renal insufficiency with tertiary hyperparathyroidism and femoral neck fracture. During observation of the patient in our hospital were found hyperparathyroid osteodystrophy, medial right femoral neck fracture, very high level of parathormone (1969,0 pg/ml, tumorous of right (16,0 × 17,0 mm and left (23,0 × 17,0 mm parathyroid glands located behind of inferior thyroid poles during ultrasound research. Surgical exploration has found bilateral whitish parathyroid tumorous with invasion to right recurrent laryngeal nerve. Were performed right hemithyroidectomy, left thyroid lobe resection and central neck dissections. Parathormone level has decreased to 3.5 times (up to 582 pg/ml. 20 minutes later after bilateral inferior parathyroidectomies. The regular hemodialysis was restore and six months later was successfully undertaken the hip prosthetics. Two year later after the surgery signs of parathyroid cancer relapses were no found.

  1. When, how and why to treat the neck in patients with esthesioneuroblastoma: a review.

    Science.gov (United States)

    Zanation, Adam M; Ferlito, Alfio; Rinaldo, Alessandra; Gore, Mitchell R; Lund, Valerie J; McKinney, Kibwei A; Suárez, Carlos; Takes, Robert P; Devaiah, Anand K

    2010-11-01

    Esthesioneuroblastoma is an uncommon tumor that presents in the sinonasal cavity and anterior skull base. Cervical metastases are not frequently found on initial presentation but eventually occur in 20-25% of these patients. This presents the treating physician with the difficult decision as to how and when to treat the neck in this disease. The aims of this study were to provide a comprehensive review of the incidence of N+ disease at presentation, make recommendations about the optimal treatment strategy of patients with N+ disease, explain the role of elective neck treatment in patients with N0 disease, and comment on treatment of patients with late cervical metastases that require salvage therapy, using the literature review of the incidence and treatment of neck disease in patients with esthesioneuroblastoma. This review revealed an approximately 5-8% incidence of cervical nodal metastasis at the time of presentation. Combined modality therapy with surgery and radiotherapy is recommended to treat the N+ neck at the time of diagnosis and later. Chemotherapy may have a role combined with radiation treatment, but there are little data to support this. There is limited evidence to substantiate the use of elective neck dissection or elective radiotherapy in the clinically and radiologically N0 neck. Patients who have late cervical metastases have a clear survival advantage (59 vs. 14%) when treated with combined surgery and radiotherapy relative to single modality methods alone. The results indicate that the management of the neck in esthesioneuroblastoma continues to be a significant challenge in the treatment algorithm of these complex patients.

  2. Bilateral vertebral artery dissection possibly precipitated in delayed fashion as a result of roller coaster rides.

    Science.gov (United States)

    Schneck, Michael; Simionescu, Monica; Bijari, Armita

    2008-01-01

    A 34-year-old woman presented with a 5-month history of persistent vertigo after multiple roller coaster rides, followed by neck pain for 1 month and then 2 weeks of blurred vision related to diplopia. She was ultimately found to have bilateral cervical vertebral artery dissection. The images are described and the literature is reviewed regarding late diagnosis of vertebral dissection and prior cases of roller coaster-associated dissection.

  3. Clinical and radiological evaluation in vertebral artery dissections

    Directory of Open Access Journals (Sweden)

    Murat Çabalar

    2013-04-01

    Full Text Available In recent years, vertebral artery dissection (VAD is reported more frequently as a cause of young cerebrovascular accidents. It can occur spontaneously or following a neck manipulation and trauma. The patients were 3 females (mean age: 35±26 years and 7 males (mean age: 37.71±4.96 years. Only 2 patients described neck trauma. Cerebellar findings were prominent in all cases. On radiological investigation, vascular changes of vertebral arteries were detected bilaterally in 2 cases, right in 5 and left in 3 cases. All the cases were treated with anticoagulant therapy and cured but 1 with sequela. Prognosis of vertebral artery dissection is generally good by early diagnosis and treatment. In this article, we reported clinical and radiological properties of 10 vertebral artery dissection cases.

  4. [Malignant mucosal melanoma of the head and neck].

    Science.gov (United States)

    Slavícek, A; Astl, J; Válková, D; Betka, J; Petruzelka, L

    2000-01-01

    Mucosal melanoma comparison to cutaneous melanoma of the head and neck are rare and do poorly. Approximately 0.5-2% of all melanomas occur from the mucous membranes of aerodigestive tract. Most common site of the tumor are the nasal cavity and paranasal sinuses but melanoma of the oral cavity are described too. Therapy usually consists of surgical resection with or without postoperative radiotherapy and immunochemotherapy eventually. The definite role of a kind of therapy in the treatment of mucosal melanoma is not remains to be defined as the small number of cases make prospective study challenging. This article reviews 19 patients with mucosal melanoma of the head and neck treated at the Department of ENT and Head and Neck Surgery Charles University of Prague since 1980 to 1999. Clinical data were obtained from the patient's charts. Analysis of the metastatic disease, type of therapy and follow-up was retrospectively reviewed. The site of the tumor was the lateral wall of the nasal cavity (five cases), nasal septum (four cases), maxilar cavity (two cases), and ethmoidal cavity, orbitoethmoidal complex, nasopharynx, saccus lacrimalis to ethmoidal sinuses diffused, tonsilla (one case each) and hypopharynx (two cases). Primary treatment was surgical resection in ten cases, in one case with radiation therapy, and in seven cases chemotherapy. In three cases were diagnostic surgery only and one patient was without therapy. Three patients received radical neck dissection more. Four patients were treated radiation therapy and three chemotherapy after surgery. In two cases were surgery after primary radiotherapy. For nine cases of recurrence of the disease were surgery (in five cases) and chemotherapy (in four cases). Overal and disease free interval was from 2 to 22 month, approximately 9.3 month and 3-year survival was 41.18%.

  5. 前外侧和外侧联合入路的股骨颈肿瘤刮除植骨及内固定术%Surgical technique of combined anterior-lateral and lateral approach in the management of bone tumor of femoral neck

    Institute of Scientific and Technical Information of China (English)

    伦登兴; 胡永成; 黄洪超; 夏群; 苗军; 于金虎

    2011-01-01

    Objective To explore surgical procedure of combined anterior-lateral and lateral approach for the treatment of bone tumors of femoral neck. Methods Forty patients with bone tumors of femoral neck treated in Tianjin Hospital were included from July 2005 to August 2009. Of the patients, 12 who were treated with curettage and bone graft through combined anterior-lateral and lateral incision were analyzed in this study. There were 7 males and 5 females with an average age of 34 years ranging from 17 to 68 years. 4 patients were diagnosed as chondroblastoma, 2 giant cell tumor, 3 fibrous dysplasia, and 3 single bone cysts. 7 patients suffered from pathologic fractures, and 5 had presented thin cortical bone because of tumor involvement. There were 1 tumor located in H1 zone, 4 in H2 zone and 7 in H1,2 zone according to ISOLS femoral neck classification. All patients were treated by curettage and bone graft via anterior-lateral approach, 10 cases underwent internal fixation with anatomical plate, and 2 cases with canulated screws with lateral approach. Results The follow-up time ranged from 10 to 68 months with an average of 35 months.Pain disappeared in all patients, and there were not recurrence of tumor, pathologic fractures and avascular necrosis. One case had complained of lateral femoral skin numbness which may be caused by injures of femoral lateral nerves. One case had difficulties in the valgus of hip joint. The mean MSTS score was 29.2 points ranging from 27 to 30 points. Conclusion Anterior approaches of "SP" incision is helpful to thorough curettage which decrease the risk of recurrence due to good visualization and intemal fixation is easy to perform via lateral approaches. The result suggested that combined anterior-lateral "SP" and lateral incision is liable option in treatment of bone tumors of femoral neck.%目的 探讨前外侧和外侧联合入路肿瘤刮除植骨重建治疗股骨颈骨肿瘤的疗效.方法 2005年7月至2009年8月采用前外侧

  6. Cooccurrence of Metastatic Papillary Thyroid Carcinoma and Salmonella Induced Neck Abscess in a Cervical Lymph Node

    Science.gov (United States)

    Kim, Jae-Myung; Jung, Eun Jung; Song, Eun Jin; Kim, Dong Chul; Jeong, Chi-Young; Ju, Young-Tae; Lee, Young-Joon; Hong, Soon-Chan; Choi, Sang-Kyung; Ha, Woo-Song

    2017-01-01

    Cervical lymph node metastasis is common in patients with papillary thyroid carcinoma (PTC). Salmonella species are rarely reported as causative agents in focal infections of the head and neck. The cooccurrence of lymph node metastasis from PTC and a bacterial infection is rare. This report describes a 76-year-old woman with a cervical lymph node metastasis from PTC and Salmonella infection of the same lymph node. The patient presented with painful swelling in her left lateral neck region for 15 days, and neck ultrasonography and computed tomography showed a cystic mass along left levels II–IV. The cystic mass was suspected of being a metastatic lymph node; modified radical neck dissection was performed. Histopathological examination confirmed the presence of PTC in the resected node and laboratory examination of the combined abscess cavity confirmed the presence of Salmonella Typhi. Following antibiotic sensitivity testing of the cultured Salmonella Typhi, she was treated with proper antibiotics. Cystic lesions in lymph nodes with metastatic cancer may indicate the presence of cooccurring bacterial infection. Thus, culturing of specimen can be option to make accurate diagnosis and to provide proper postoperative management. PMID:28261270

  7. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Morton Adam

    2012-12-01

    Full Text Available Abstract A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection following chiropractic treatment in a pregnant woman published in the literature.

  8. Preauricular transparotid approach to mandibular condylar fractures without dissecting facial nerves.

    Science.gov (United States)

    Yabe, Tetsuji; Tsuda, Tomoyuki; Hirose, Shunsuke; Ozawa, Toshiyuki

    2013-07-01

    Preauricular transparotid approach without dissecting the facial nerve was used for surgical treatment of 15 condylar fractures in 14 patients. The parotid fascia was opened just above the fracture site, and by dissecting the parotid gland and masseter muscle, the fracture was directly exposed. The facial nerve itself was not dissected expressly. All fractures could be reduced accurately and fixed firmly with miniplates. A direct approach just above the fracture site provided good vision of the fracture, avoiding facial nerve palsy caused by strong retraction. Moreover, by not dissecting the facial nerve, the operation time was shortened. This approach was useful for surgical treatment of both condylar neck and subcondylar fractures.

  9. Mastectomy using ultrasonic dissection

    DEFF Research Database (Denmark)

    Galatius, Hanne; Okholm, Mette; Hoffmann, Jack

    2003-01-01

    Seroma formation is the most common complication after mastectomy. Among the several known etiological factors the surgical procedure used may be of importance for seroma formation. This prospective study was carried out to evaluate the ultrasonic energy dissection technique and its effect...... on seroma formation and other complications: 59 patients with operable breast cancer underwent modified radical mastectomy, performed in 30 of them with an Ultracision Harmonic scalpel and in 29 with scissors and electrocautery. In all cases a standard level II axillary dissection was performed...... groups. In conclusion, neither clinical advantages or disadvantages of the ultrasound dissection technique were found....

  10. Radiotherapy of Neck Node Metastases from an Unknown Primary Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2007-12-15

    Purpose: The aim of this retrospective analysis was to analyze the results of radiotherapy administered to patients with neck node metastases from an unknown primary cancer, with or without neck dissection. Materials and Methods: From January 1986 to December 2005, 88 patients with neck node metastases from an unknown primary cancer were treated with curative intent. The age of the patients ranged from 35 to 74 years (median age, 59 years). There were 74 male and 14 female patients. Distribution of patients by N status was as follows: N1, 4 patients; N2a, 10 patients; N2b, 48 patients; N2c, 8 patients; N3, 18 patients. Fifty-one patients underwent neck dissection and 37 patients had only a biopsy (31 patients had fine-needle aspiration and 6 patients had an excisional biopsy). All patients received radiotherapy. The follow-up time ranged from 1 to 154 months, with a median time of 32 months. Results: The overall survival (OS) and disease-free survival (DFS) rate at 5 years were 43.9% and 41.7%, respectively. The factors associated with the OS rate were neck dissection, and a subsequent primary tumor. Factors associated with the DFS rate were N stage, neck dissection, and a subsequent primary tumor. Neck failure was noted in 15 patients, distant metastases in 18 patients, and a subsequent primary tumor in 8 patients. Conclusion: With comprehensive radiotherapy given to the bilateral neck and the potential mucosal sites, good survival rates can be obtained in patients with neck node metastases from an unknown primary cancer. However, considering the side effects, a randomized trial is required to determine the optimal radiotherapy volume.

  11. Is dissection humane?

    OpenAIRE

    Hasan, Tabinda

    2011-01-01

    Dissection is being jeopardized in the modern medical education. It has unrelentingly faced the lashes of time and has been the scapegoat for numerous convenient curricula reforms and subjective biases. The cadaver is unparallel in establishing core knowledge among the medical community and it needs to be appreciated in a new light in the “cyber anatomy” realm of today. This article elucidates the medical and ethical validity of continuing human body dissection in medicine which outweighs all...

  12. Hinged Dissections Exist

    CERN Document Server

    Abbott, Timothy G; Charlton, David; Demaine, Erik D; Demaine, Martin L; Kominers, Scott D

    2007-01-01

    We prove that any finite collection of polygons of equal area has a common hinged dissection. That is, for any such collection of polygons there exists a chain of polygons hinged at vertices that can be folded in the plane continuously without self-intersection to form any polygon in the collection. This result settles the open problem about the existence of hinged dissections between pairs of polygons that goes back implicitly to 1864 and has been studied extensively in the past ten years. Our result generalizes and indeed builds upon the result from 1814 that polygons have common dissections (without hinges). We also extend our common dissection result to edge-hinged dissections of solid 3D polyhedra that have a common (unhinged) dissection, as determined by Dehn's 1900 solution to Hilbert's Third Problem. Our proofs are constructive, giving explicit algorithms in all cases. For a constant number of planar polygons, both the number of pieces and running time required by our construction are pseudopolynomial...

  13. Painless aortic dissection presenting as paraplegia.

    Science.gov (United States)

    Colak, Necmettin; Nazli, Yunus; Alpay, Mehmet Fatih; Akkaya, Ismail Olgun; Cakir, Omer

    2012-01-01

    Acute dissection of the aorta can be life-threatening. As a presenting manifestation of aortic dissection, neurologic complications such as paraplegia are rare. Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of the legs, with no chest or back pain. His medical history included coronary artery bypass grafting. Physical examination revealed pulseless lower extremities, and computed tomography showed aortic dissection from the ascending aorta to the common iliac arteries bilaterally. A lumbar catheter was inserted for cerebrospinal fluid drainage, and axillary arterial cannulation was established. With the use of cardiopulmonary bypass, the aortic dissection was corrected, and the previous coronary artery grafts were reattached. The surgery restored spinal and lower-extremity perfusion, and the patient walked unaided from the hospital upon his discharge 5 days later. Although acute aortic dissection presenting as paraplegia is rare, it should be considered in patients who have pulseless femoral arteries bilaterally and sudden-onset paraplegia, despite no pain in the chest or back. Prompt diagnosis and intervention can prevent morbidity and death.

  14. Cerebrum-cervical arterial dissection in adults during sports and recreation

    Directory of Open Access Journals (Sweden)

    Yara Dadalti Fragoso

    2015-01-01

    Full Text Available Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities.Methods Retrospective data on patients with arterial dissection related to sports and recreation.Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature.Conclusion Arterial dissection may be a complication from practicing sports.

  15. Comparison of electromyographic activity and range of neck motion in violin students with and without neck pain during playing.

    Science.gov (United States)

    Park, Kyue-nam; Kwon, Oh-yun; Ha, Sung-min; Kim, Su-jung; Choi, Hyun-jung; Weon, Jong-hyuck

    2012-12-01

    Neck pain is common in violin students during a musical performance. The purpose of this study was to compare electromyographic (EMG) activity in superficial neck muscles with neck motion when playing the violin as well as neck range of motion (ROM) at rest, between violin students with and without neck pain. Nine violin students with neck pain and nine age- and gender-matched subjects without neck pain were recruited. Muscle activity of the bilateral upper trapezius, sternocleidomastoid, and superficial cervical extensor muscles was measured using surface EMG. Kinematic data on neck motion while playing and active neck ROM were also measured using a three-dimensional motion analysis system. Independent t-tests were used to compare EMG activity with kinematic data between groups. These analyses revealed that while playing, both the angle of left lateral bending and leftward rotation of the cervical spine were significantly greater in the neck pain group than among those without neck pain. Similarly, EMG activity of the left upper trapezius, both cervical extensors, and both sternocleidomastoid muscles were significantly greater in the neck pain group. The active ROM of left axial rotation was significantly lower in the neck pain group. These results suggest that an asymmetric playing posture and the associated increased muscle activity as well as decreased neck axial rotation may contribute to neck pain in violin students.

  16. Economic analysis of FDG-PET-guided management of the neck after primary chemoradiotherapy for node-positive head and neck squamous cell carcinoma.

    Science.gov (United States)

    Pryor, David I; Porceddu, Sandro V; Scuffham, Paul A; Whitty, Jennifer A; Thomas, Paul A; Burmeister, Bryan H

    2013-09-01

    The aim of this economic analysis was to model different strategies using pre-treatment nodal stage or nodal response assessment with CT or positron emission tomography (PET)/CT to determine the need for neck dissection. A cost-minimization analysis was developed on the basis of probability data from a prospective study of PET-guided management of the neck in patients achieving a complete response at the primary site. Costs were derived from our institution's activity-based clinical costing system. The effect of uncertainty was tested with sensitivity and scenario analyses including nationally representative cost data. Strategies incorporating PET had a 7% rate for neck dissection compared with 44% for CT-guided and 90% for planned neck dissection. The cost per patient was A$16,502 for planned neck dissection, A$8014 for CT-guided, and A$2573 for PET-guided. A policy with PET used only for incomplete response on CT was the least-cost strategy (A$2111). Policies incorporating PET remained the most efficient for all sensitivity/scenario analyses. The incorporation of PET/CT into nodal response assessment significantly reduced the number of unnecessary neck dissections and generated considerable cost savings in our cohort. Copyright © 2012 Wiley Periodicals, Inc.

  17. Neurofibromatosis of the head and neck: classification and surgical management.

    Science.gov (United States)

    Latham, Kerry; Buchanan, Edward P; Suver, Daniel; Gruss, Joseph S

    2015-03-01

    Neurofibromatosis is common and presents with variable penetrance and manifestations in one in 2500 to one in 3000 live births. The management of these patients is often multidisciplinary because of the complexity of the disease. Plastic surgeons are frequently involved in the surgical management of patients with head and neck involvement. A 20-year retrospective review of patients treated surgically for head and neck neurofibroma was performed. Patients were identified according to International Classification of Diseases, Ninth Revision codes for neurofibromatosis and from the senior author's database. A total of 59 patients with head and neck neurofibroma were identified. These patients were categorized into five distinct, but not exclusive, categories to assist with diagnosis and surgical management. These categories included plexiform, cranioorbital, facial, neck, and parotid/auricular neurofibromatosis. A surgical classification system and clinical characteristics of head and neck neurofibromatosis is presented to assist practitioners with diagnosis and surgical management of this complex disease. The surgical management of the cranioorbital type is discussed in detail in 24 patients. The importance and safety of facial nerve dissection and preservation using intraoperative nerve monitoring were validated in 16 dissections in 15 patients. Massive involvement of the neck extending from the skull base to the mediastinum, frequently considered inoperable, has been safely resected by the use of access osteotomies of the clavicle and sternum, muscle takedown, and brachial plexus dissection and preservation using intraoperative nerve monitoring. Therapeutic, IV.

  18. A case of carotid artery dissection devoleped after swimming: The role of heterezygote C677T MTHFR gen mutation

    Directory of Open Access Journals (Sweden)

    Alevtina Ersoy

    2013-12-01

    Full Text Available Carotid artery dissection is one of the most important causes of cerebral stroke in young age. Although most cases of carotid artery dissection appear spontaneously, sometimes it may result from a microtrauma which the patient does not take seriously. This article reports a case of extracranial internal carotid artery dissection starting from intense swimming and manifesting itself only as neck swelling and neck pain. Other analyses showed that the patient also suffered from a cronic venous sinus thrombosis and stroke. Moreover, genetic testing revealed a MTHFR gene mutation. This case is presented because of the multiple vascular events are seen in the same patient.

  19. Thyroid papillary carcinoma arising in ectopic thyroid tissue within a neck branchial cyst

    Directory of Open Access Journals (Sweden)

    Di Fiore Agnese

    2006-05-01

    Full Text Available Abstract Background Thyroid gland derives from one median anlage at the base of the tongue, and from the two fourth branchial pouches. A number of anomalies may occur during their migration. These can be in form of ectopic tissues, which are frequently found along the course of thyroglossal duct and rarely in other sites, many of these may develop same diseases as the thyroid gland. Case presentation A 36-years-old female presented with a 3 month history of left side neck mass. The mass disappeared following aspiration of brown colored fluid, which on cytological examination showed cells with nuclear irregularities that warranted the resection of the lesion. The histology demonstrated a thyroid papillary carcinoma arising within the branchial cyst. Thereafter, the patient underwent a total thyroidectomy with central lymph nodes dissection. Histology showed a multifocal papillary carcinoma with central lymph nodes metastases. Only four cases of primary thyroid carcinomas in neck branchial cyst have been described so far. Conclusion In a lateral cystic neck mass, although rare, occurrence of ectopic thyroid tissue and presence of a papillary thyroid carcinoma should be kept in mind.

  20. Neck Injuries and Disorders

    Science.gov (United States)

    ... or upper arms. Muscle strain or tension often causes neck pain. The problem is usually overuse, such as from ... or accidents, including car accidents, are another common cause of neck pain. Whiplash, a soft tissue injury to the neck, ...

  1. Cervical artery dissection: early recognition and stroke prevention.

    Science.gov (United States)

    Cadena, Rhonda

    2016-07-01

    Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke.

  2. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    2014-01-01

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  3. Endoscopic submucosal dissection

    DEFF Research Database (Denmark)

    Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry

    2015-01-01

    they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality...

  4. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  5. [Cervical recurrence in the pathologically negative neck (pNO): finding a needle in a haystack].

    Science.gov (United States)

    Lassaletta, L; Bernáldez, R; González, T; Gavilán, J

    2002-01-01

    Recurrence in the pathologically negative neck (pN0) is one of the most striking events occurring in head and neck tumors. It is not even mentioned in many neck dissection studies. The presence of micrometastases has been suggested as an explanation for this event. In accordance to a recent study performed in our institution, we bring up this controversial issue. A definitive explanation for recurrence in the pN0 has not yet been proposed.

  6. Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

    Science.gov (United States)

    Kılınç, Hasan Erkan; Harput, Gülcan; Baltacı, Gül; İnce, Deniz İnal

    2014-01-01

    Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were evaluated. Cyriax cervical mobilization for 10 minutes and scapular mobilization for 10 repetition 10 sets were performed to patients as treatment protocol. After treatment, 24 hours after and a week after evaluations of neck pain and deep cervical muscles endurance were repeated. Results: Before treatment Neck pain Visual Analog Scale scores was 5.78±1.43 point, 2.80±1.99 point after treatment, 24 hours later 3.36±2.12 point, one week later 3.91±2.24 point. This alteration was found significant statistically (p<0.01). Before treatment deep cervical flexor muscle endurance score was 27.25±17.74 sec, after treatment 39.46±25.20 sec, 24 hours later 38.67±28.43 and one week later 40.11±27.82 sec. This alteration was also found significant statistically (p=0.01). Conclusion: Initially neck pain scores in our subjects decreased quickly, after 24 hours these scores increased but last scores were below first neck pain level in a week follow-up. Deep neck cervical flexor muscles test scores also increased quickly, after 24 hours later this scores were stable along a week. Mobilization techniques are effective methods on neck pain and endurance in chronical mechanic neck pain patients.

  7. Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases.

    Science.gov (United States)

    Yang, Jing; Gong, Yanping; Yan, Shuping; Zhu, Jingqiang; Li, Zhihui; Gong, Rixiang

    2016-08-01

    The extent of lateral neck dissection (LND) in surgical resection of papillary thyroid carcinoma (PTC) with clinically lateral LNM (LLNM) remains controversial. We aimed to explore the frequency of and risk factors for level V LNM in patients with solitary PTC and clinically LLNM. To analyze the frequency and risk factors for level V LNM, we retrospectively reviewed 220 solitary PTC patients who underwent total thyroidectomy, bilateral central neck dissection, and therapeutic LND. LLNM were present in 82.3% patients, and levels II-V LNM were present in 45.9%, 62.7%, 55.5%, and 12.3% patients, respectively. Ipsilateral level V LNM was significantly associated with tumor size >10 mm, extrathyroidal extension, ipsilateral central LNM ratio ≥50%, and contralateral central LNM (CLNM), bilateral CLNM, and simultaneous levels II-IV LNM. Contralateral CLNM was an independent risk factor for level V LNM. In patients with solitary PTC and clinically LLNM, level V LNM was relatively uncommon. Therefore, routine level V lymphadenectomy may be unnecessary in these patients unless level V LNM is suspected on preoperative examination or associated risk factors, especially contralateral CLNM, are present.

  8. Muscle parameters for musculoskeletal modelling of the human neck

    NARCIS (Netherlands)

    Borst, J.; Forbes, P.A.; Happee, R.; Veeger, H.E.J.

    2011-01-01

    Background: To study normal or pathological neuromuscular control, a musculoskeletal model of the neck has great potential but a complete and consistent anatomical dataset which comprises the muscle geometry parameters to construct such a model is not yet available. Methods: A dissection experiment

  9. Muscle parameters for musculoskeletal modelling of the human neck

    NARCIS (Netherlands)

    Borst, J.; Forbes, P.A.; Happee, R.; Veeger, H.E.J.

    2011-01-01

    Background: To study normal or pathological neuromuscular control, a musculoskeletal model of the neck has great potential but a complete and consistent anatomical dataset which comprises the muscle geometry parameters to construct such a model is not yet available. Methods: A dissection experiment

  10. [Resolution of a neck chylous fistula with oral diet treatment].

    Science.gov (United States)

    Cánovas, B; Morlán, M A; Familiar, C; Sastre, J; Marco, A; López, J

    2005-01-01

    Chylous fistula after neck dissection is a well-described complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part.

  11. Free Flap Procedures for Reconstruction After Head and Neck Cancer.

    Science.gov (United States)

    Kini, Erin

    2015-12-01

    Patients with head and neck cancer are seeking improved surgical procedures to avoid severe defects that result from head and neck cancer resection. Free flap reconstruction provides vascularized tissue that has been transferred from a distant donor site on a patient's body to a recipient site, markedly improving wound closure and protecting structures of the head and neck. This article discusses free flap procedures for reconstruction after head and neck cancer resection, including the following procedure phases: airway protection and neck dissections, tumor resection, flap harvest, microvascular anastomosis of the flap, and reconstruction and closure. The article also explains specific risk factors for patients undergoing free flap procedures that have been identified in the literature and include procedure length, hypothermia, and pressure injuries. Each of these factors is discussed regarding its specific effect on this patient population, and the nursing interventions to reduce these risks are identified.

  12. Are all hands-on activities equally effective? Effect of using plastic models, organ dissections, and virtual dissections on student learning and perceptions.

    Science.gov (United States)

    Lombardi, Sara A; Hicks, Reimi E; Thompson, Katerina V; Marbach-Ad, Gili

    2014-03-01

    This study investigated the impact of three commonly used cardiovascular model-assisted activities on student learning and student attitudes and perspectives about science. College students enrolled in a Human Anatomy and Physiology course were randomly assigned to one of three experimental groups (organ dissections, virtual dissections, or plastic models). Each group received a 15-min lecture followed by a 45-min activity with one of the treatments. Immediately after the lesson and then 2 mo later, students were tested on anatomy and physiology knowledge and completed an attitude survey. Students who used plastic models achieved significantly higher overall scores on both the initial and followup exams than students who performed organ or virtual dissections. On the initial exam, students in the plastic model and organ dissection treatments scored higher on anatomy questions than students who performed virtual dissections. Students in the plastic model group scored higher than students who performed organ dissections on physiology questions. On the followup exam, when asked anatomy questions, students in the plastic model group scored higher than dissection students and virtual dissection students. On attitude surveys, organ dissections had higher perceived value and were requested for inclusion in curricula twice as often as any other activity. Students who performed organ dissections were more likely than the other treatment groups to agree with the statement that "science is fun," suggesting that organ dissections may promote positive attitudes toward science. The findings of this study provide evidence for the importance of multiple types of hands-on activities in anatomy laboratory courses.

  13. Measuring the osteochondral connection of the femoral head and neck in patients with impingement femoroacetabulare by determining the angle of two alpha in lateral and anteroposterior hip radiographic images

    Directory of Open Access Journals (Sweden)

    Anđelković Zoran

    2013-01-01

    Full Text Available Background/Aim. Femoroacetabular impingement, a pathophysiological mechanism of small morphological changes of the hip leads to early arthritic changes. The aim of this study was to present a simple method for the quantification of femoral head and neck junction in patients with cam form of femoroacetabular impingement, in standardized anteroposterior and profile DUNN 90 radiograms of the hips. Methods. In standardized anteroposterior and profile DUNN 90 images of the hips we determined the angle of 2 alpha, defined by our own original method. We tested 141 hips in 81 patients without clinical signs of femoroacetabular impingement, and 153 hips in 76 patients with clinically clear signs of femoroacetabular impingement. Results. The value of the angle 2 alpha in anteroposterior hip radiograms was on average 113.7° for the patients with clinical symptoms of impingement, and 84.2° for the control group of patients (p ≤ 0.0001, and in DUNN 90 profile radiography of the hip, the value of 2 alpha angle in the patients group was 97.2°, and 74.6° in the control group (p ≤ 0.0001. The proposed method of determining the angle 2 alpha showed a high level sensitivity (97.8% and specificity (98.7 and positive predictive value (98.6%. It was false positive in only 1.3%, and false negative in 2.12% of patients. Conclusion. Using standardized anteroposterior and profile radiographs of the hips, and without determination of femoral neck axis in patients with femoroacetabular impingement with the cam effect at the junction of the femoral head and neck, we proposed the method of measuring joint abnormalities of femoral head and neck junction, very capable to predict the disease development in an asymptomatic risk group of patients and high sensitive in the diagnosis of the disease in the group of patients.

  14. Pancreaticoduodenectomy with early superior mesenteric artery dissection

    Institute of Scientific and Technical Information of China (English)

    Yu-Fei Xu; Zuo-Jin Liu; Jian-Ping Gong

    2010-01-01

    BACKGROUND: Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive human tumors. At present, surgical resection is the only potentially curative treatment. Early neck division is inadequate when invasion of the superior mesenteric artery (SMA) is suspected or in cases of replaced or accessory right hepatic artery. Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival. DATA SOURCES: English-language medical databases, PubMed, ELSEVIER and SPRINGERLINK, were searched for articles on"posterior approach pancreaticoduodenectomy","superior mesenteric artery ifrst approach", "retroperitoneal tissue","hanging maneuver", and related topics. RESULTS:The modiifcation allowed the surgeon to early identify the nonresectability of a replaced right hepatic artery if present, enabling complete dissection of the right side of the SMA and portal vein as well as complete excision of the retroportal pancreatic lamina. CONCLUSION: Pancreaticoduodenectomy with early retro-pancreatic dissection is a useful and safe technical variant, which is indicated for the improvement of the safety and curative effect of the procedure.

  15. Predictors of pain among patients with head and neck cancer.

    Science.gov (United States)

    Shuman, Andrew G; Terrell, Jeffrey E; Light, Emily; Wolf, Gregory T; Bradford, Carol R; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A; Duffy, Sonia A

    2012-12-01

    OBJECTIVE To determine predictors of pain 1 year after the diagnosis of head and neck cancer. DESIGN Prospective, multisite cohort study. SETTING Three academically affiliated medical centers. PATIENTS The study population comprised 374 previously untreated patients with carcinoma of the upper aerodigestive tract. MAIN OUTCOME MEASURES Participants were surveyed before treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the 36-Item Short-Form Instrument (SF-36) bodily pain score 1 year after diagnosis. RESULTS The mean SF-36 bodily pain score at 1 year was 65, compared with 61 at the time of diagnosis (P = .004), and 75, the population norm (lower scores indicate worse pain). Variables independently associated with pain included pretreatment pain score (P neck dissection (P = .001), feeding tube (P = .05), xerostomia (P pain medication (P neck cancer pain and current smoking and problem drinking did not reach significance (P = .07 and P = .08, respectively). CONCLUSIONS Aggressive pain management may be indicated for patients with head and neck cancer who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco use, and alcohol abuse may also reduce pain and improve quality of life among patients with head and neck cancer.

  16. Zuckerkandl's tubercle and its relationship to the recurrent laryngeal nerve: A cadaveric dissection and meta-analysis.

    Science.gov (United States)

    Henry, Brandon Michael; Sanna, Beatrice; Vikse, Jens; Graves, Matthew J; Spulber, Alexandru; Witkowski, Cecylia; Tomaszewska, Iwona M; Tubbs, R Shane; Tomaszewski, Krzysztof A

    2017-12-01

    Zuckerkandl's tubercle (ZT), when present, is an anatomical landmark by which surrounding structures such as the recurrent laryngeal nerve (RLN) can be identified intraoperatively. This study aimed to investigate the prevalence and anatomical characteristics of Zuckerkandl's tubercle by combining cadaveric dissection with a meta-analysis. Through October 2016, an extensive search of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science was completed. Extracted data, along with the findings from our cadaveric dissections, were pooled into a meta-analysis to assess the prevalence and size of ZT and its relationship to the RLN. The pooled prevalence estimate of a ZT was 70.2% in the general population, 65.0% of which were considered Grade 0 tubercles (<1.0cm) and 35.0% Grade 1 (≥1.0cm). The RLN ran posteromedially to the ZT in 82.7% of cases, laterally to it in 8.7%, and on top of it in 8.6% of hemilarynges. RLN palsy is a common postoperative complication and cause for litigation following neck surgery. The ZT is a common component of the thyroid gland and with proper knowledge, surgeons can use it to reliably and quickly identify the RLN during operative procedures. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. [Unilateral atypical neck pain in Eagle syndrome].

    Science.gov (United States)

    Lonka, Matilde Mia; Schousboe, Lars Peter

    2012-04-30

    This article is an introduction to Eagle syndrome as a differential diagnosis in patients with lateral neck pain, a symptom, which is often difficult to diagnose and where the accepted treatment covers a variety of forms. This was the case for a 51 year-old man with lateral neck pain and a crunchy sensation/sound when he turned his head. After years of pain, the right examination and a computed tomography finally suggested Eagle syndrome. The patient had severe symptoms and was treated with an operation by which part of the ossificated stylohyoid ligament was removed. The operation relieved him of all his symptoms.

  18. Aortic dissection: magnetic resonance imaging.

    Science.gov (United States)

    Amparo, E G; Higgins, C B; Hricak, H; Sollitto, R

    1985-05-01

    Fifteen patients with suspected or known aortic dissection were imaged with magnetic resonance (MR). Thirteen of these patients were eventually shown to have dissection. In most instances the diagnosis was established by aortography and/or computed tomography (CT) prior to the MR study. Surgical proof (6/13) and/or aortographic proof (10/13) were available in 11/13 patients with aortic dissection. MR demonstrated the intimal flap and determined whether the dissection was type A or type B. In addition, MR: differentiated between the true and false lumens; determined the origins of the celiac, superior mesenteric, and renal arteries from the true or false lumen in the cases where the dissection extended into the abdominal aorta (8/12); allowed post-surgical surveillance of the dissection; and identified aortoannular ectasia in the three patients who had Marfan syndrome. In addition to the 13 cases with dissection, there were two cases in whom the diagnosis of dissection was excluded by MR. Our early experience suggests that MR can serve as the initial imaging test in clinically suspected cases of aortic dissection and that the information provided by MR is sufficient to manage many cases. Additionally, MR obviates the use of iodinated contrast media.

  19. Woody hardness - a novel classification for the radiotherapy-treated neck.

    Science.gov (United States)

    Colbert, S D; Mitchell, D A; Brennan, P A

    2015-04-01

    The term 'woody neck' is widely used by surgeons and oncologists to describe the fibrosis that can occur following radiotherapy for head and neck malignancy. These soft tissue and skin changes can be compounded by neck dissection, either before or after radiotherapy. To our knowledge, there is no classification published in the literature to describe the degree of woody hardness following treatment. We propose a simple ABC classification for varying degrees of indurated oedema and neck fibrosis secondary to radiotherapy or long-standing pathology, using the hardness of different woods to enable a suitable description to be made of severity.

  20. Similar dissection of sets

    CERN Document Server

    Akiyama, Shigeki; Okazaki, Ryotaro; Steiner, Wolfgang; Thuswaldner, Jörg

    2010-01-01

    In 1994, Martin Gardner stated a set of questions concerning the dissection of a square or an equilateral triangle in three similar parts. Meanwhile, Gardner's questions have been generalized and some of them are already solved. In the present paper, we solve more of his questions and treat them in a much more general context. Let $D\\subset \\mathbb{R}^d$ be a given set and let $f_1,...,f_k$ be injective continuous mappings. Does there exist a set $X$ such that $D = X \\cup f_1(X) \\cup ... \\cup f_k(X)$ is satisfied with a non-overlapping union? We prove that such a set $X$ exists for certain choices of $D$ and $\\{f_1,...,f_k\\}$. The solutions $X$ often turn out to be attractors of iterated function systems with condensation in the sense of Barnsley. Coming back to Gardner's setting, we use our theory to prove that an equilateral triangle can be dissected in three similar copies whose areas have ratio $1:1:a$ for $a \\ge (3+\\sqrt{5})/2$.

  1. A Research on Neck Movement and Injury After Driver Backs to Seat in the Later Stage of Frontal Crash%正面碰撞后期驾驶员复位后颈部运动与伤害的研究

    Institute of Scientific and Technical Information of China (English)

    洪亮; 葛如海

    2015-01-01

    In view of the present situation of the lack of research on the neck injury in the later stage of crash process after driver backs to seat with his waist pressing against seat back under the actions of air bag reaction force and the constraint force of seat belt, the movement states of driver’s upper and lower necks is studied to ana-lyze the effects of seat parameters on neck injuries. To this end, based on the related dimension of passenger com-partment and performance parameters of a car, a simulation model for the constraint system of driver is built with crash simulation software MADYMO and a simulation is conducted and verified by tests. The results indicate that the peak stretch bending moment of upper neck decreases with the reduction of headrest stiffness while decreasing the stiffness of upper seat back and the rotational stiffness of seatback recliner can significantly reduce the peak stretch bending moments of both upper and lower neck and neck injury indicators Nkm and Nij . Reasonably increasing the forward inclination of headrest can greatly reduce the peak stretch bending moment of lower neck, but over doing may lead to the increase of neck injury indicators.%针对目前国内外对正面碰撞后期,驾驶员在安全气囊反弹力与安全带约束力作用下,向后复位运动,其腰部与座椅靠背接触后的颈部伤害研究很少的现状,进行了驾驶员上、下颈部运动状态研究,并分析座椅特征参数对颈部伤害的影响。为此以某型轿车乘员室相关尺寸和性能参数为依据,采用碰撞仿真软件 MADYMO 建立了驾驶员约束系统仿真模型,并进行仿真与试验验证。结果表明:减小座椅头枕刚度,可降低上颈部伸张弯矩峰值;减小靠背上部刚度与靠背倾角调节器转动刚度,可显著降低上、下颈部伸张弯矩峰值和颈部伤害指标 Nkm与 Nij;增加头枕前倾角,可大幅降低下颈部伸张弯矩峰值,但过大的头

  2. Robotic thyroidectomy with central neck dissection using axillo-bilateral-breast approach:a comparison to open conventional approach%达芬奇机器人腋乳径路与传统开放手术治疗甲状腺微小癌的对照研究

    Institute of Scientific and Technical Information of China (English)

    贺青卿; 朱见; 范子义; 庄大勇; 郑鲁明; 周鹏; 岳涛; 于芳; 侯蕾

    2016-01-01

    目的 评估经腋乳径路达芬奇机器人外科操作系统下甲状腺全切除(或甲状腺腺叶峡部切除)+中央区淋巴结清扫治疗甲状腺微小癌的效果和可行性.方法 回顾性分析2014年2月至12月在济南军区总医院接受达芬奇机器人经腋乳径路甲状腺全切除(或甲状腺腺叶峡部切除)+中央区淋巴结清扫的40例甲状腺微小癌患者的临床资料(机器人组),并与同期40例接受传统开放低位领式小切口相同手术的甲状腺微小癌患者(开放组)进行比较.采用t检验或x2检验比较两组患者基本情况、手术时间、术中出血量、术后住院时间、清扫淋巴结数目、疼痛视觉模拟评分、并发症发生率及美容效果.结果 40例患者均顺利完成机器人经腋乳径路甲状腺手术.中央区淋巴结转移者机器人组和开放组分别为14例和15例.机器人组手术时间为(130±12) min,长于开放组的(98±11)min(t=12.432,P<0.05),疼痛视觉模拟评分机器人组1.9±0.9,低于开放手术组的3.9±1.1(t =8.900,P<0.05).术后美容效果数字评分系统得分机器人组9.1±0.5,优于开放组的4.8±1.5(t=17.200,P<0.05).术中估计出血量、平均引流量、术后住院时间、清除淋巴结数目及并发症发生率两组间均差异无统计学意义(P>0.05).结论 达芬奇机器人腋乳径路甲状腺全切+中央区淋巴结清扫治疗甲状腺微小癌可达到传统开放手术的外科治疗效果,且具有更好的美容效果.%Objective To evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).Methods The clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group

  3. Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Lyudmila Andreevna Kalashnikova

    2013-01-01

    Full Text Available The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA. Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH. The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.. The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases and in ICA dissection less frequently (about 5%. Magnetic resonance (MR angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

  4. Acute aortic dissection: be aware of misdiagnosis

    Directory of Open Access Journals (Sweden)

    Asteri Theodora

    2009-02-01

    Full Text Available Abstract Background Acute aortic dissection (AAD is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. Methods From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT, transthoracic echocardiography (TTE and coronary angiography. Results Initial misdiagnosis occurred in fifteen patients (31% later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients. Conclusion Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.

  5. Huge dissected ascending aorta associated with pseudo aneurysm and aortic coarctation feridoun.

    Science.gov (United States)

    Sabzi, Feridoun; Khosravi, Donya

    2015-07-01

    We report a unique case of chronic dissection of the ascending aorta complicated with huge and thrombotic pseudoaneurysm in a patient with coarctation of descending aorta. Preoperative investigations such as transesophageal echocardiography (TEE) confirmed the diagnosis of dissection. Intraoperative findings included a12 cm eccentric bulge of the right lateral side of dilated the ascending aorta filled with the clot and a circular shaped intimal tear communicating with an extended hematoma and dissection of the media layer. The rarity of the report is an association of the chronic dissection with huge pseudoaneurysm and coarctation. The patient underwent staged repair of an aneurysm and coarctation and had an uneventful postoperative recovery period.

  6. "Dissection" of a Hair Dryer

    Science.gov (United States)

    Eisenstein, Stan; Simpson, Jeff

    2008-01-01

    The electrical design of the common hair dryer is based almost entirely on relatively simple principles learned in introductory physics classes. Just as biology students dissect a frog to see the principles of anatomy in action, physics students can "dissect" a hair dryer to see how principles of electricity are used in a real system. They can…

  7. Isolated superior mesenteric artery dissection

    Directory of Open Access Journals (Sweden)

    Lalitha Palle

    2010-01-01

    Full Text Available Isolated superior mesenteric artery (SMA dissection without involvement of the aorta and the SMA origin is unusual. We present a case of an elderly gentleman who had chronic abdominal pain, worse after meals. CT angiography, performed on a 64-slice CT scanner, revealed SMA dissection with a thrombus. A large artery of Drummond was also seen. The patient was managed conservatively.

  8. Cutaneous angiosarcoma of head and neck

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    Rita Vora

    2014-01-01

    Full Text Available Cutaneous angiosarcoma is a rare aggressive tumor of capillary and lymphatic endothelial cell origin. Cutaneous angiosarcoma of the head and neck regions seems to be a distinctive neoplasm with characteristic clinicopathologic features that differ from angiosarcoma in other anatomic locations. Angiosarcoma, regardless of their setting, has a bad prognosis. We presented here a case of 80 years old male, with multiple nontender grouped purple to red hemorrhagic vesicular and bullous lesions over left lower cheek and upper neck area, with bilateral cervical lymph nodes since 1 month. Computed tomography thorax showed nodular opacities in the right upper and midzones. Excisional biopsy showed characterstic "dissection of collagen" with mild nuclear atypia. Immunohistochemistry showed tumor cell positive for CD-31 and Fli-1. Patient died within 1 month of presentation.

  9. Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge.

  10. Automatic Dissection Of Plantlets

    Science.gov (United States)

    Batchelor, B. G.; Harris, I. P.; Marchant, J. A.; Tillett, R. D.

    1989-03-01

    Micropropagation is a technique used in horticulture for generating a monoclonal colony of plants. A tiny plantlet is cut into several parts, each of which is then replanted. At the moment, the cutting is performed manually. Automating this task would have significant economic benefits. A robot designed to dissect plants would need to be equipped with intelligent visual sensing. This article is concerned with the image acquisition and processing techniques which such a machine might use. A program, which can calculate where to cut a plant with an "open" structure, is presented. This is expressed in the ProVision language, which is described in another article presented at this conference. (Article 1002-65)

  11. Zygomatico-orbital artery as a recipient vessel for microsurgical head and neck reconstruction.

    Science.gov (United States)

    Higashino, Takuya; Sawamoto, Naoya; Hirai, Rintaro; Arikawa, Masaki

    2013-07-01

    The selection of recipient vessels in head and neck reconstruction is one of the key factors influencing its difficulty and outcome. We report a case of a microsurgical scalp reconstruction using the zygomatico-orbital artery as a recipient vessel.A 71-year-old woman had intractable skin ulcers on her head after neurosurgeries. Computed tomography angiography findings showed that the superficial temporal artery was obstructed and that the zygomatico-orbital artery ran forward and upward. She underwent scalp reconstruction using a free anterior lateral thigh flap. The zygomatico-orbital artery was dissected distally, cut, and turned over cranially. The diameter of the zygomatico-orbital artery was 1.2 mm. The blood flow through the zygomatico-orbital artery was sufficient. The thinned scalp area was excised, and some of the titanium devices and infectious tissues were removed. An anterior lateral thigh flap measuring 20 × 9 cm was harvested and transferred to the defect in the head. The discrepancy in calibers was within double, and the zygomatico-orbital artery fit the descending branch of the lateral circumflex femoral artery. The flap was transferred successfully.The zygomatico-orbital artery is one of the branches from the external carotid artery and supports the suprazygomatic territory. The zygomatico-orbital artery is present in 78% to 92% of people and originates from the superficial temporal artery and sometimes from the frontal branch of superficial temporal artery. The mean diameter of the zygomatico-orbital artery at origin is reported to be 1.20 mm. The zygomatico-orbital artery is another option as a recipient vessel in head and neck reconstruction.

  12. Variation of neck muscle strength along the human cervical spine.

    Science.gov (United States)

    Oi, Nelson; Pandy, Marcus G; Myers, Barry S; Nightingale, Roger W; Chancey, Valeta Carol

    2004-11-01

    The aim of this study was to describe and explain the variation of neck muscle strength along the cervical spine. A three-dimensional model of the head-neck complex was developed to test the hypothesis that the moment-generating capacity of the neck musculature is lower in the upper cervical spine than in the lower cervical spine. The model calculations suggest that the neck muscles can protect the lower cervical spine from injury during extension and lateral bending. The maximum flexor moment developed in the lower cervical spine was 2 times higher than that developed in the upper spine. The model also predicted that the neck musculature is 30% stronger in the lower cervical spine during lateral bending. Peak compressive forces (up to 3 times body weight) were higher in the lower cervical spine. These results are consistent with the clinical finding that extension loading of the neck often leads to injuries in the upper cervical spine. Analysis of the model results showed that neck flexor strength was greater in the lower cervical spine because of the relatively large size of the sternocleidomastoid muscle. The hyoid muscles developed significant flexor moments about the joints of the upper cervical spine, as these muscles had relatively large flexor moment arms; however, this effect was offset by the action of the sternocleidomastoid, which exerted a large extensor moment in the upper spine. Lateral bending strength of the neck muscles was governed by geometry (i.e., moment arms) rather than by muscle size.

  13. The frequency of distribution of cervical metastases according to the neck level in patients with larynx cancer

    Directory of Open Access Journals (Sweden)

    Engin Şengül

    2012-09-01

    Full Text Available Objectives: In this study we aimed to assess the frequencyof distribution for cervical metastases, according to the necklevel in patients with larynx cancer who underwent neck dissection.In addition, we also evaluated the safety of selectiveneck dissection compared to comprehensive neck dissectionespecially in preoperative N0 patients.Materials and methods: In our experience, to determine thefrequency of metastases in each level, the specimen is sentfor pathological examination by dividing each level separatelyafter neck dissection. In our study; we retrospectively analysedthe medical records of 145 laryngeal cancer patientswho were treated with surgery (total or partial laryngectomyas primary treatment and combined with neck dissectionbetween 2005 and 2010 in our Otolaryngology Department.The patients with the diagnosis of laryngeal cancer who underwentsurgery without neck dissection were excluded fromthe analysis.Results: Level I or level V involvement was not observedin preoperative N0 cases. In cases that had contralateralinvolvement, there was ipsilateral involvement too and allof these cases were preoperative N+ cases. The classificationbased on the distribution of levels of 145 cases’ cervicalmetastases revealed that among ipsilateral involvements, 1(0.6% was detected at level IA, 32 (22% at level IIA, 3 (2%at level IIB, 19 (13% at level III, 2 (1.3% at level IV and1 (1.3% at level V. When contralateral involvement considered,13 (8.9% were detected at level IIA and 1 (0.6% atlevel III.Conclusions: The neck specimen findings of 145 laryngealcancer patients treated with surgery as either total or partiallaryngectomy and combined with neck dissection revealedthat the most common metastases were observed at thelevel IIA and level III; however metastases at level I, levelIIB, level IV and level V were least common. Those findingsindicated that selective neck dissection was a safe surgicalapproach (levels II-IV in T1 T2 N0 cases. J Clin Exp

  14. How common is hypothyroidism after external radiotherapy to neck in head and neck cancer patients?

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    Nirmala Srikantia

    2011-01-01

    Full Text Available Purpose: To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine performing of thyroid function tests during follow-up. Materials and Methods: This is a prospective nonrandomized study of 45 patients of head and neck cancer, receiving radiotherapy (RT. Thyroid stimulating hormone and T4 estimations were done at baseline and at 4 months and 9 months following RT. Results: Of the 45 patients, 37(82.2 % were males and eight (17.8 % were females. All patients received radiation to the neck to a dose of >40Gy. 35.6% received concurrent chemotherapy. Two patients underwent prior neck dissection. Fourteen patients (31.1% were found to have clinical hypothyroidism (P value of 0.01. Five (11.1% patients were found to have subclinical hypothyroidism with a total 19 of 45 (42.2% patients developing radiation-induced hypothyroidism. Nine of 14 patients with clinical hypothyroidism were in the age group of 51 to 60 years (P=0.0522. Five of 16 patients who received chemoradiation and nine of 29 who received RT alone developed clinical hypothyroidism. Above 40 Gy radiation dose was not a relevant risk factor for hypothyroidism. Conclusion: Hypothyroidism (clinical or subclinical is an under-recognized morbidity of external radiation to the neck which is seen following a minimum dose of 40 Gy to neck. Recognizing hypothyroidism (clinical or subclinical early and treating it prevents associated complications. Hence, thyroid function tests should be made routine during follow-up.

  15. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

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    Christos Bakoyiannis

    2012-01-01

    Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  16. Rejuvenation of the neck with liposuction and ancillary techniques.

    Science.gov (United States)

    Stebbins, William G; Hanke, C William

    2011-01-01

    An aesthetically pleasing neck is an important component of physical appearance and a frequently targeted area for a variety of rejuvenative procedures. In appropriately selected patients, liposuction of the neck using tumescent local anesthesia can effectively render a more youthful appearance to the anterior and lateral neck by removing superficial adipose tissue and redraping the skin. This article will review all aspects of neck liposuction, including neck and lower face anatomy, proper patient selection and evaluation, necessary equipment, as well as all peri-procedural management. An in-depth discussion of administration of tumescent local anesthesia and proper liposuction technique is also included. Lastly, a number of ancillary techniques to further enhance the appearance of the neck including laser lipolysis, fractional ablative CO(2) resurfacing, and treatment of platysmal banding will be briefly discussed. © 2011 Wiley Periodicals, Inc.

  17. Spontaneous isolated celiac artery dissection

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    Tuba Cimilli Ozturk

    2011-01-01

    Full Text Available Dyspepsia with mild, stabbing epigastric discomfort without history of trauma is a very common symptom that emergency physicians see in their daily practice. Vascular emergencies, mostly the aortic dissection and aneurysm, are always described in the differential diagnosis with persistent symptoms. Isolated celiac artery dissection occurring spontaneously is a very rare diagnosis. The involvement of branch vessels is generally observed and patients show various clinical signs and symptoms according to the involved branch vessel. Here we are presenting a case with spontaneous isolated celiac artery dissection, without any branch vessel involvement or visceral damage, detected by computed tomography scans taken on admission.

  18. Chronic neck pain and masticatory dysfunction.

    Science.gov (United States)

    Catanzariti, Jean-François; Debuse, Thierry; Duquesnoy, Bernard

    2005-12-01

    Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD) with craniocervical asymmetry is the most common clinical picture. The pain is usually located in the suboccipital region and refractory to conventional treatment. The time pattern may be suggestive, with nocturnal arousals or triggering by temporomandibular movements. MD should be strongly suspected in patients with at least two of the following: history of treated or untreated MD, unilateral temporomandibular joint pain and clicking, lateral deviation during mouth opening, and limitation of mouth opening (less than three fingerbreadths). Rheumatologists should consider MD among causes of neck pain, most notably in patients with abnormal craniocervical posture, signs linking the neck pain to mastication, and clinical manifestations of MD. Evidence suggesting that MD may cause neck pain has been published. However, studies are needed to determine whether treatment of MD can relieve neck pain.

  19. Forgotten triangles of neck.

    Science.gov (United States)

    Singh, Manpreet; Vashistha, Arpit; Chaudhary, Manoj; Kaur, Gagandeep

    2016-01-01

    The purpose of this manuscript is to add some more information in the present scientific literature on these nearly forgotten triangles of surgical importance. The neck is an area that lends itself to anatomical geometry, such as triangles. Many triangles of the neck have been described, and some are well-known, yet, some have been nearly forgotten, i.e., Lesser's triangle, Farabeuf triangle, Pirogoff's triangle, and Beclard's triangle. From the anatomic and surgical point of view, the neck is an amazingly interesting place. It is like a connection where crucial functional units meet and pass. Added surgical landmarks are always helpful to the surgeon while dealing with the neck. Described triangles of neck in this article are always reliable and constant landmarks for head and neck surgeons.

  20. Head and Neck

    DEFF Research Database (Denmark)

    Højgaard, Liselotte; Berthelsen, Anne Kiil; Loft, Annika

    2014-01-01

    Positron emission tomography (PET)/computed tomography with FDG of the head and neck region is mainly used for the diagnosis of head and neck cancer, for staging, treatment evaluation, relapse, and planning of surgery and radio therapy. This article is a practical guide of imaging techniques......, including a detailed protocol for FDG PET in head and neck imaging, physiologic findings, and pitfalls in selected case stories....

  1. Congenital neck masses: embryological and anatomical perspectives

    Directory of Open Access Journals (Sweden)

    Zahida Rasool

    2013-08-01

    Full Text Available Neck masses are a common problem in paediatric age group. They tend to occur frequently and pose a diagnostic dilemma to the ENT surgeons. Although the midline and lateral neck masses differ considerably in their texture and presentation but the embryological perspective of these masses is not mostly understood along with the fundamental anatomical knowledge. The article tries to correlate the embryological, anatomical and clinical perspectives for the same. [Int J Res Med Sci 2013; 1(4.000: 329-332

  2. Contemporary insights into the management of type A aortic dissection.

    Science.gov (United States)

    Tolis, George; Sundt, Thoralf M

    2016-10-01

    Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years. In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.

  3. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

  4. Rhinoplasty: the lateral crura-alar ring.

    Science.gov (United States)

    Daniel, Rollin K; Palhazi, Peter; Gerbault, Olivier; Kosins, Aaron M

    2014-05-01

    Rhinoplasty surgeons routinely excise or incise the lateral crura despite nostril rim retraction, bossa, and collapse. Given recent emphasis on preserving the lateral crura, a review of the lateral crura's anatomy is warranted. The authors quantify specific anatomical aspects of the lateral crura in cadavers and clinical patients. This was a 2-part investigation, consisting of a prospective clinical measurement study of 40 consecutive rhinoplasty patients (all women) and 20 fresh cadaver dissections (13 males, 1 female). In the clinical phase, the alar cartilages were photographed intraoperatively and alar position (ie, orientation), axis, and width were measured. Cadaver dissections concentrated on parts of the lateral crura (alar cartilages and alar ring) that were inaccessible clinically. Average clinical patient age was 28 years (range, 14-51 years). Average cadaver age was 74 (range, 57-88 years). Clinically, the distance of the lateral crura from the mid-nostril point averaged 5.9 mm, and the cephalic orientation averaged 43.6 degrees. The most frequent configuration of the axis was smooth-straight in the horizontal axis and a cephalic border higher than the caudal border in the vertical axis. Maximal lateral crura width averaged 10.1 mm. In the cadavers, average lateral crural dimensions were 23.4 mm long, 6.4 mm wide at the domal notch, 11.1 mm wide at the so-designated turning point (TP), and 0.5 mm thickness. The accessory cartilage chain was present in all dissections. The lateral crura-alar ring was present in all dissections as a circular ring continuing around toward the anterior nasal spine but not abutting the pyriform. The lateral crura (1) begins at the domal notch and ends at the accessory cartilages, (2) exhibits a distinct TP from the caudal border, (3) has distinct horizontal and vertical vectors, and (4) should have a caudal border higher than the cephalic border. Alar malposition may be associated with position, orientation, or configuration.

  5. Sagittal alignment of the cervical spine after neck injury.

    Science.gov (United States)

    Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J

    2013-07-01

    The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

  6. A comparison of retention of anatomical knowledge in an introductory college biology course: Traditional dissection vs. virtual dissection

    Science.gov (United States)

    Taeger, Kelli Rae

    Dissection has always played a crucial role in biology and anatomy courses at all levels of education. However, in recent years, ethical concerns, as well as improved technology, have brought to the forefront the issue of whether virtual dissection is as effective or whether it is more effective than traditional dissection. Most prior research indicated the two methods produced equal results. However, none of those studies examined retention of information past the initial test of knowledge. Two groups of college students currently enrolled in an introductory level college biology course were given one hour to complete a frog dissection. One group performed a traditional frog dissection, making cuts in an actual preserved frog specimen with scalpels and scissors. The other group performed a virtual frog dissection, using "The Digital Frog 2" software. Immediately after the dissections were completed, each group was given an examination consisting of questions on actual specimens, pictures generated from the computer software, and illustrations that neither group had seen. Two weeks later, unannounced, the groups took the same exam in order to test retention. The traditional dissection group scored significantly higher on two of the three sections, as well as the total score on the initial exam. However, with the exception of specimen questions (on which the traditional group retained significantly more information), there was no significant difference in the retention from exam 1 to exam 2 between the two groups. These results, along with the majority of prior studies, show that the two methods produce, for the most part, the same end results. Therefore, the decision of which method to employ should be based on the goals and preferences of the instructor(s) and the department. If that department's goals include: Being at the forefront of new technology, increasing time management, increasing student: teacher ratio for economic reasons, and/or ethical issues, then

  7. EXTRACAPSULAR SPREAD IN IPSILATERAL NECK METASTASIS: AN IMPORTANT PROGNOSTIC FACTOR IN LARYNGEAL CANCER

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the impact of extracapsular spread (ECS) in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer.Methods The study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens.Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance.Results We found pathological neck metastases in 80 patients. Among them, 26 cases (32.5%) had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N (pN) stages (pN1 3.7%, pN2a 25.0%, pN2b 50. 0%, and pN2c 55.6%; P=0.001). ECS incidence also increased with number of positive nodes ( 1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66. 7%; P<0.001). Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS (46.2%vs.24. 1%, P=0 046; 34. 6% vs. 7.4%, P =0. 002). The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS (23.1% vs. 57.4%,P=0.013).Conclusion ECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.

  8. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

    Science.gov (United States)

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin

    2012-06-01

    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

  9. Surface electromyography signals from neck muscles during different craniocervical postures in a lateral recumbent position%颈部不同姿势侧卧位时颈肌表面肌电信号分析及其意义

    Institute of Scientific and Technical Information of China (English)

    张芳; 刘怀霞; 卢君艳; 陶涛涛; 程博; 蒋松鹤

    2010-01-01

    Objective To survey cervical myoelectric signals during craniocervical flexion, neutral and extension postures, and to explore the evidence that proper head position can alleviate cervical muscle fatigue in a lateral recumbent position. Methods Surface electromyography (sEMG) signals were detected from the sternocleidomastoid, upper trapezius and erector spinae muscles of 30 young subjects bilaterally during craniocervical flexion,neutral and extension postures in the left lateral recumbent position. The integrated trace area (IEMG) and median frequency (MF) were estimated. Results The average IEMG of the sternocleidomastoid muscles was significantly lower in flexion than in extension bilaterally. The average IEMG of the erector spinae muscles was lower in extension than in flexion bilaterally, and the difference was again significant. The IEMGs of the upper trapezius muscle showed no significant difference on average in the three postures bilaterally. There was no significant MF difference in any of the muscles. Conclusions The muscles in the cervical back were less activated during craniocervical extension in a lateral recumbent position. A little cranicocervical extension is optimal while resting in a lateral recumbent position.%目的 观察颈部不同屈伸姿势侧卧位时颈部肌肉表面肌电信号的变化,探讨侧卧位睡姿时头颈部的良好摆放姿势.方法 表面肌电图观察30例青年志愿者左侧卧位下,颈部前屈、中立及后伸时双侧胸锁乳突肌、斜方肌上部、颈竖脊肌的表面肌电信号,采用积分肌电值(IEMG)和中位频率(MF)分析.结果 胸锁乳突肌前屈位与后伸位比较,IEMG数值较低,差异有统计学意义(P0.05),3对肌肉在3种体位时MF值比较差异无统计学意义(P>0.05).结论 侧卧位头颈部后伸时颈背部肌肉紧张度较小,提示侧卧位睡眠时头颈部较佳姿势为稍后伸位.

  10. MODIFIED DISSECTION OF SUBPECTORAL SPACE FOR BETTER AESTHETICAL AUGMENTED BREAST

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To reconstruct an augmented breast that resembles a virginal one that is difficult to be achieved by the traditional technique. Methods We modified the dissection of the subpectoral space by extending it over the sternum edge 1cm medially and beyond the breast crease 2cm inferiorly, yet keeping strictly the upper border of the space on the third rib and the lateral border on the anterior axillary line. Results All 50 patients were satisfied with their augmented breasts which nearly resembled the virginal ones. Conclusion Our modified dissection enabled the mammary implant to stay in the position where it originally was and not be pushed upward and laterally by the pectoral muscle contraction as usually seen by the traditional technique.

  11. Spontaneous internal carotid artery dissection.

    Science.gov (United States)

    Khimenko, L P; Esham, H R; Ahmed, W

    2000-10-01

    Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We report a case of spontaneous internal carotid artery dissection in a 38-year-old woman with a cortical stroke and visual disturbances as initial symptoms. The diagnosis was confirmed by magnetic resonance imaging/angiography and by angiography. Prompt anticoagulation was instituted, and the patient had complete resolution of symptoms. Cervicocephalic arterial dissection should be included in the differential diagnosis of the causes of cerebrovascular events.

  12. ``Dissection'' of a Hair Dryer

    Science.gov (United States)

    Eisenstein, Stan; Simpson, Jeff

    2008-12-01

    The electrical design of the common hair dryer is based almost entirely on relatively simple principles learned in introductory physics classes. Just as biology students dissect a frog to see the principles of anatomy in action, physics students can "dissect" a hair dryer to see how principles of electricity are used in a real system. They can discover how engineers solve problems such as how to vary between low and high heat and fan speed by simply moving the position of a single switch. Principles of alternating versus direct current, series and parallel circuits, electrical safety, voltage dividing, ac rectification, power, and measurement of resistance and continuity all come in to play.

  13. Visual Hallucinations in a Patient with Horner's Syndrome Secondary to Internal Carotid Dissection

    OpenAIRE

    2014-01-01

    A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the ...

  14. Visual Hallucinations in a Patient with Horner's Syndrome Secondary to Internal Carotid Dissection

    DEFF Research Database (Denmark)

    Singh, Amardeep; Mortzos, Panteleimon; Sørensen, Torben Lykke

    2014-01-01

    A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, n......, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the underlying mechanism....

  15. Papillary thyroid microcarcinoma in Graves′ disease presenting as a cystic neck mass

    Directory of Open Access Journals (Sweden)

    Milind Patil

    2015-01-01

    Full Text Available The presentation of papillary thyroid microcarcinoma (PTMC as a solitary cystic neck mass is uncommon. Additionally, its association with Graves′ disease is very rare. We report a case of occult PTMC, who presented with a cystic neck mass in the background of Graves′ disease without any goiter. Imaging like ultrasound of neck, single photon emission computed tomography-CT (SPECT-CT, and technetium scan failed to detect any lesion in the thyroid, which was picked up only by the contrast-enhanced computed tomography (CECT of neck. The patient underwent total thyroidectomy with right modified lymph node dissection. Our case highlights the presentation of metastatic PTMC as a differential diagnosis of a cystic neck mass even in a patient with Graves′ disease without any thyroid enlargement.

  16. The Three-Dimensional Architecture of the Internal Capsule of the Human Brain Demonstrated by Fiber Dissection Technique

    Directory of Open Access Journals (Sweden)

    Cristina Goga

    2015-01-01

    Full Text Available The fiber dissection technique involves peeling away white matter fiber tracts of the brain to display its three-dimensional anatomic arrangement. The intricate three-dimensional configuration and structure of the internal capsule (IC is not well defined. By using the fiber dissection technique, our aim was to expose and study the IC to achieve a clearer conception of its configuration and relationships with neighboring white matter fibers and central nuclei. The lateral and medial aspects of the temporal lobes of twenty, previously frozen, formalin-fixed human brains were dissected under the operating microscope using the fiber dissection technique.

  17. Spontaneous dissection of the coronary and vertebral arteries post-partum: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Cenkowski Marta

    2012-11-01

    Full Text Available Abstract Background Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period. Case presentation This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery. Conclusion We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.

  18. Lateral Concepts

    Directory of Open Access Journals (Sweden)

    Christopher Gad

    2016-06-01

    Full Text Available This essay discusses the complex relation between the knowledges and practices of the researcher and his/her informants in terms of lateral concepts. The starting point is that it is not the prerogative of the (STS scholar to conceptualize the world; all our “informants” do it too. This creates the possibility of enriching our own conceptual repertoires by letting them be inflected by the concepts of those we study. In a broad sense, the lateral means that there is a many-to-many relation between domains of knowledge and practice. However, each specific case of the lateral is necessarily immanent to a particular empirical setting and form of inquiry. In this sense lateral concepts are radically empirical since it locates concepts within the field. To clarify the meaning and stakes of lateral concepts, we first make a contrast between lateral anthropology and Latour’s notion of infra-reflexivity. We end with a brief illustration and discussion of how lateral conceptualization can re-orient STS modes of inquiry, and why this matters.

  19. Cadaveric study: study of lateral circumflex femoral arterial origin in Rajkot

    Directory of Open Access Journals (Sweden)

    Pradip Rameshbhai Chauhan

    2015-05-01

    Full Text Available Background: Lateral circumflex femoral artery contributes cruciate, trochanteric and knee joint anastomosis. In addition Lateral circumflex femoral artery flaps are used for the reconstruction of large tissue loss in the head and neck region, aortopopliteal bypass, coronary artery bypass grafting and extracranial intracranial bypass surgery. This work was carried out (a to study the origin of lateral circumflex femoral artery and (b to measure and compare (between male and female the circumference at its origin. Methods: In this cross sectional study, 51 femoral triangles from 26 (18 male and 08 female human adult cadavers were dissected and studied at P.D.U. government medical college, Rajkot, Gujarat. Site of origin of lateral circumflex femoral artery was identified and noted. The distance of origin of the artery from the origin of profunda femoris artery was measured and noted. Circumference at the level of origin was measured and diameter was calculated. Collected data was analysed by standard statistical formulas with the help of Microsoft excel 2013 and Epi info 7TM software. Results: 90.19% lateral circumflex femoral arteries originated from the profunda femoris artery and remaining 9.81% from the femoral artery. The mean distance of origin of the artery from the origin of profunda femoris artery was 18.44 mm. Lateral circumflex femoral artery circumference and diameter were significantly different between male and female (95% confidence interval, P <0.05. Conclusion: In this presented study maximum distance of origin of the artery from the origin was 65 mm while minimum distance of origin was 6 mm. In addition difference in circumference of the artery was statistically significant. [Int J Res Med Sci 2015; 3(5.000: 1066-1069

  20. Insights into acute aortic dissection

    NARCIS (Netherlands)

    Trimarchi, S.

    2012-01-01

    Aortic dissection represents one of the most catastrophic and complex cardiovascular diseases. Its origin is related to an intimal tear with course of blood flow into the aortic wall and division of the aortic lumen into two different lumens, defined as the true and false lumen, separated by a

  1. Animal Rights Activism Threatens Dissection.

    Science.gov (United States)

    Holden, Constance

    1990-01-01

    Discussed is the movement against the use of dissections in science laboratories. Examples of protests across the United States are included. Compared is the plight of using animals in a biology classroom and the demise of the teaching of evolution in some areas. (KR)

  2. Virtual dissection of pig carcasses

    DEFF Research Database (Denmark)

    Vester-Christensen, Martin; Erbou, Søren Gylling Hemmingsen; Hansen, Mads Fogtmann

    2009-01-01

    This paper proposes the use of computed tomography (CT) as a reference method for estimating the lean meat percentage (LMP) of pig carcasses. The current reference is manual dissection which has a limited accuracy due to variability between butchers. A contextual Bayesian classification scheme...

  3. Spontaneous aortic dissection within an infrarenal AAA.

    Science.gov (United States)

    Griffin, Kathryn J; Bailey, Marc A; McAree, Barry; Mekako, Anthony; Berridge, David C; Nicholson, Tony; Scott, D Julian A

    2012-12-01

    Aortic dissection occurring in the infrarenal abdominal aorta is uncommon. We present the case of a patient presenting with an enlarging abdominal aortic aneurysm and concurrent dissection (with associated radiological imaging) and briefly discuss the literature relating to this phenomenon.

  4. Dissection and preparation of viscera for plastination

    OpenAIRE

    Creus Tacies, Xavier

    2014-01-01

    Póster 1- Get a better understanding of the sistem coronary dissection, one of the most important from the point of anatomical and functional aspects. 2- Learn the plastination technique applying on a previously dissected equine heart.

  5. [Dissection is still important when learning anatomy].

    Science.gov (United States)

    Knudsen, Britt Mejer; Søe, Niels H; Jensen, Nina Vendel; Langebæk, Rikke; Dahlin, Lars B

    2013-05-20

    Dissection and prosection require a donation programme of cadavers for education and research. The importance of maintaining the donation programme and the significance of dissection as a teaching method when learning anatomic structures and obtaining surgical skills are evaluated.

  6. Melanoma - neck (image)

    Science.gov (United States)

    This melanoma on the neck is variously colored with a very darkly pigmented area found centrally. It has irregular ... be larger than 0.5 cm. Prognosis in melanoma is best defined by its depth on resection.

  7. Spontaneous internal carotid dissection in a 38-year-old woman: a case report

    Directory of Open Access Journals (Sweden)

    Kareem Abed

    2015-10-01

    Full Text Available This case report describes a patient found to have amaurosis fugax as a result of non-traumatic internal carotid dissection. Monocular blindness can be due to multiple causes including keratitis, acute glaucoma, vitreous hemorrhage, uveitis, retinal vascular occlusion, retinal detachment, optic neuropathy, trauma, or vascular malformations. In the setting of headache, neck pain, and an otherwise normal ophthalmic examination, this case report highlights the importance of recognizing transient ischemic attack and carotid artery dissection in the differential diagnosis. To further clarify the diagnosis, carotid ultrasound may aid diagnosis as was seen in this case, where decreased internal carotid artery velocities were found and subsequent CT angiography of the neck confirmed a diagnosis of carotid dissection. If a dissection is present, progression of symptoms may indicate impending cerebral infarction and warrant immediate attention. Antiplatelet therapy is the first-line treatment with anticoagulation, thrombolysis, and surgery reserved for cases of recurrent, progressive symptomatic episodes. Surgical options include endovascular repair such as angioplasty, stent placement, embolization, surgical revascularization, and bypass.

  8. Head and neck teratomas

    OpenAIRE

    Shah, Ajaz; Latoo, Suhail; Ahmed, Irshad; Malik, Altaf H

    2009-01-01

    Teratomas are complex lesions composed of diverse tissues from all 3 germinal cell layers and may exhibit variable levels of maturity. Head and neck teratomas are most commonly cervical with the oropharynx (epignathus) being the second commonest location. In this article, clinical presentation, behaviour and associated significance of head and neck teratomas have been highlightened. Because of their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic cli...

  9. [Modern treatment of type B dissections

    DEFF Research Database (Denmark)

    Klitfod, L.; Baekgaard, N.; Just, S.

    2008-01-01

    Rapid classification is essential in the management of aortic dissections, as Type A dissections require surgery, while the optimal treatment of Type B dissections is controversial. Medical treatment with antihypertensive medication and analgesics has so far been the main treatment of uncomplicated...... Type B dissections, while surgery has been reserved for complications and persistent pain in spite of medical treatment. Endovascular techniques are less invasive than open repair and show promising early results Udgivelsesdato: 2008/9/8...

  10. [Modern treatment of type B dissections

    DEFF Research Database (Denmark)

    Klitfod, L.; Baekgaard, N.; Just, S.

    2008-01-01

    Rapid classification is essential in the management of aortic dissections, as Type A dissections require surgery, while the optimal treatment of Type B dissections is controversial. Medical treatment with antihypertensive medication and analgesics has so far been the main treatment of uncomplicated...... Type B dissections, while surgery has been reserved for complications and persistent pain in spite of medical treatment. Endovascular techniques are less invasive than open repair and show promising early results Udgivelsesdato: 2008/9/8...

  11. Anatomical variation in the anterolateral ligament of the knee and a new dissection technique for embalmed cadaveric specimens.

    Science.gov (United States)

    Parker, Matthew; Smith, Heather F

    2016-12-18

    Claes et al. recently documented and described the anterolateral ligament (ALL) of the knee, demonstrating its existence in 97% of their samples. Here, we further examined the anatomy of this ligament, documented its morphological variation, and assessed the feasibility of its dissection in preserved cadaveric specimens. To achieve this, we dissected 53 preserved cadaveric knees and documented their morphological variation in the anterolateral ligament. The originally described dissection technique for identifying and following the ALL requires flexion of the knee, a state which is often not possible in stiff, preserved cadavers. Here, we describe and confirm the feasibility of an alternate dissection technique in which the quadriceps femoris tendon is incised, for use on specimens in which flexion of the undissected knee is not possible. We also identify a novel technique for assessing whether the anterolateral ligament is absent from a specimen or has simply been obliterated or overlooked, using the lateral inferior genicular vasculature. These dissection techniques have great potential for the dissection of preserved cadavers used in gross anatomy laboratories, and we discuss the applications of such an approach in student-led dissections. Our dissections also uncovered noticeable variation in the anterolateral ligament course and position. Most notably, it often inserts significantly more laterally than the classical presentation (30.2%), or originates more proximally with superficial fibers extending superiorly and laterally over the distal femur (7.5%).

  12. Prediction of three dimensional maximum isometric neck strength.

    Science.gov (United States)

    Fice, Jason B; Siegmund, Gunter P; Blouin, Jean-Sébastien

    2014-09-01

    We measured maximum isometric neck strength under combinations of flexion/extension, lateral bending and axial rotation to determine whether neck strength in three dimensions (3D) can be predicted from principal axes strength. This would allow biomechanical modelers to validate their neck models across many directions using only principal axis strength data. Maximum isometric neck moments were measured in 9 male volunteers (29±9 years) for 17 directions. The 3D moments were normalized by the principal axis moments, and compared to unity for all directions tested. Finally, each subject's maximum principal axis moments were used to predict their resultant moment in the off-axis directions. Maximum moments were 30±6 N m in flexion, 32±9 N m in lateral bending, 51±11 N m in extension, and 13±5 N m in axial rotation. The normalized 3D moments were not significantly different from unity (95% confidence interval contained one), except for three directions that combined ipsilateral axial rotation and lateral bending; in these directions the normalized moments exceeded one. Predicted resultant moments compared well to the actual measured values (r2=0.88). Despite exceeding unity, the normalized moments were consistent across subjects to allow prediction of maximum 3D neck strength using principal axes neck strength.

  13. Should Level V Be Routinely Dissected in N1b Papillary Thyroid Carcinoma?

    Science.gov (United States)

    Kim, Seo Ki; Park, Inhye; Hur, Nayoon; Lee, Jun Ho; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo

    2017-02-01

    For N1b papillary thyroid carcinoma (PTC) patients, modified radical neck dissection (MRND) encompassing levels II-V is generally recommended. However, routine level V dissection is controversial because of the low incidence of metastasis/recurrence in level V and the increased morbidities associated with level V dissection. This study retrospectively reviewed 646 N1b PTC patients who underwent unilateral MRND between January 1997 and June 2015. Specifically, to assess surgery-related outcomes of level V dissection, outcomes from N1b PTC patients who underwent unilateral MRND (levels II-V) were compared with those who underwent unilateral selective neck dissection (SND; levels II-IV) using propensity score matching. Overall and occult level V metastases were observed in 13.9% and 8.6% of patients, respectively. Level V recurrences were observed in only 2.26 (7.7%) recurred N1b PTC patients who underwent unilateral MRND. In multivariate analysis, three-level (II, III, and IV) simultaneous metastasis (adjusted odds ratio = 3.079, p = 0.003) was an independent predictor for level V metastasis. Under a matched condition, "shoulder syndrome" encompassing shoulder dysfunction and pain (9.1% vs. 2.7%, p = 0.002) was significantly more frequent in the MRND group than it was in the SND group. Because of the low incidence of metastasis/recurrence in level V and the clear evidence of increased morbidities, level V dissection in N1b PTC patients may be reserved for those with three-level simultaneous metastasis or clinically/radiologically evident level V metastasis.

  14. A Dissecting Competition for Medical Students

    Science.gov (United States)

    Samalia, Latika; Stringer, Mark D.

    2012-01-01

    After repeated requests from medical students for more cadaver dissection opportunities, a voluntary dissecting "competition" was initiated for the third year medical students in 2006. This has been held annually on five occasions since, offering up to 30 dissection stations and accommodating an average of 53 students (range 40-66) per year,…

  15. The incidence of electrocoagulation syndrome after endoscopic submucosal dissection in the colorectal laterally spreading tumors and the risk factors%大肠侧向发育型肿瘤内镜黏膜下剥离术后电凝综合征的发病率及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘香; 高咪; 王晟; 葛楠; 王国鑫; 郭瑾陶; 孙思予

    2015-01-01

    目的:研究大肠侧向发育型肿瘤(LST)经内镜黏膜下剥离术(ESD)后电凝综合征(PEECS)的发病率和相关的临床危险因素。方法对盛京医院内镜诊治中心2010年1月至2014年5月收治的51例大肠 LST 患者进行回顾性分析,所有患者行 ESD,分析其电凝综合征的发病率,用Logistic 回归分析发生电凝综合征的临床危险因素。结果51例患者中,电凝综合征的发病率为9.8%(5/51),病变位于直肠的发生率(7.1%,2/28)低于左半结肠(12.5%,1/8)和右半结肠(13.3%,2/15)。多因素 Logistic 回归分析显示发生电凝综合征的独立危险因素为:位于直肠以外的病变(OR =1.655,P <0.05)、病变尺寸大于25 mm(OR =1.028,P <0.05)、手术时间大于129 min (OR =1.016,P <0.05)、年龄超过62岁(OR =0.987,P <0.05)。结论对于年龄超过62岁、病变尺寸大于25 mm、预估手术时间大于129 min 及位于直肠以外的大肠 LST 患者,ESD 术中应尽量使黏膜层与固有肌层分离,减少电凝时间,术后注意禁食禁水、补液支持,并予抗感染等措施以预防 PEECS的发生。%Objective To investigate the incidence of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in the colorectal laterally spreading tumors (LST) and the risk factors. Methods Data of 51 patients with coloretral LST,treated with ESD from January 2010 to May 2014 at Shengjing hospital affiliated to China Medical University,were reviewed.The incidence of electrocoagulation syndrome was analyzed and logistic regression was used to evaluate risk.Results The incidence of electro-coagulation syndrome was 9.8%(5 /51).The incidence of tumors in the rectal area(7.1%,2 /28)was lower than that of the left half colon (12.5%,1 /8),and the right colon (13.3%,2 /15).Multivariable logistic regression analysis showed that the independent risk factors for the

  16. [Spontaneous renal artery dissection with renal infarction: a case report].

    Science.gov (United States)

    Oki, Takashi; Adachi, Hiroyuki; Tahara, Hideo; Kino, Sigeo

    2011-11-01

    A 58-year-old woman visited our hospital with nausea and right flank pain. At first abdominal ultrasonography was performed, suggesting a right renal infarction. Computed tomography (CT) study of the abdomen with intravenous contrast was performed to determine the cause of the symptoms. The scan revealed poor enhancement in the lower half of the right kidney. She was diagnosed with a right renal infarction. She was initially treated with anticoagulant therapy, but 5 days later, she complained of nausea. This time, CT demonstrated exacerbation of a right renal infarction with renal artery dissection. Based on this finding, we performed a right nephrectomy. The result of pathology was segmental arterial mediolysis. She was discharged 12 days after the surgery and is doing well at 6 months after discharge. Spontaneous renal artery dissection is a rare disease. It constitutes approximately 0.05% of arteriographic dissections. In addition, spontaneous renal artery dissection shows nonspecific symptoms. Together, these two factors may cause a delay in diagnosis.

  17. Head and neck cancers masquerading as deep neck abscesses.

    Science.gov (United States)

    Soon, Sue Rene; Kanagalingam, Jeevendra; Johari, Shirish; Yuen, Heng Wai

    2012-12-01

    Deep neck space abscesses are common otolaryngological emergencies, and prompt incision and drainage is the treatment of choice. Head and neck cancers often present with cervical metastases that may become secondarily infected. Clinical presentation is similar to a deep neck abscess. Surgical drainage of such collections has implications on subsequent treatment. In this case series, we describe six cases with this unusual presentation that were subsequently found to have a head and neck malignancy, and where three patients had their abscesses treated surgically. We aim to raise awareness of this unusual presentation of a head and neck carcinoma, and to avoid a potential pitfall in the management of deep neck abscess.

  18. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial

    DEFF Research Database (Denmark)

    Alkureishi, Lee W T; Ross, Gary L; Shoaib, Taimur

    2010-01-01

    Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes...... the long-term follow-up of a large European multicenter trial evaluating the accuracy of the technique....

  19. Timing of Incident Stroke Risk After Cervical Artery Dissection Presenting Without Ischemia.

    Science.gov (United States)

    Morris, Nicholas A; Merkler, Alexander E; Gialdini, Gino; Kamel, Hooman

    2017-03-01

    Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks. © 2017 American Heart Association, Inc.

  20. Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

    Science.gov (United States)

    Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

    2015-12-01

    Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

  1. Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study

    Directory of Open Access Journals (Sweden)

    Thomas Lucy C

    2012-09-01

    Full Text Available Abstract Background Craniocervical arterial dissection is a major cause of ischaemic stroke in young adults. The pathogenesis is not fully understood but is thought to be related to a combination of an intrinsic weakness in the arterial wall and an external trigger. Intrinsic susceptibility is thought to be a generalised arteriopathy, vascular anomaly or genetic predisposition. Proposed extrinsic factors include recent viral infection and minor mechanical trauma to the neck, including neck manipulation, which has raised concerns amongst manual practitioners in particular as to the appropriate screening of patients and avoidance of more vigorous therapeutic techniques. The presenting features of dissection may mimic a musculoskeletal presentation, creating a diagnostic dilemma for primary care practitioners. Early recognition is critical so that appropriate management can be commenced. The aims of this study are to prospectively investigate young patients ≤55 years admitted to hospital with radiologically diagnosed craniocervical arterial dissection compared to matched controls with stroke but not dissection, to identify risk factors and early presenting clinical features, so these may be more readily identified by primary care practitioners. Methods Patients ≤ 55 years presenting to hospital with craniocervical arterial dissection and controls will have their medical records reviewed and be interviewed and questioned about possible risk factors, preceding events to admission such as recent neck trauma, and presenting clinical features including any preceding transient ischaemic features. Clinical assessment will include a connective tissue screening examination to identify subclinical connective tissue disorders. Radiology and blood screening will be reviewed for typical features and inflammatory markers. Functional outcome will be reviewed to determine the burden of the stroke. Discussion This study will provide descriptive and

  2. [Microvascular anastomoses in reconstructive head and neck surgery].

    Science.gov (United States)

    Remmert, S

    1995-04-01

    At the ENT Department of the University of Lübeck, 57 microvascular tissue transplants with 129 anastomoses (61 arterial and 68 venous) have been performed in the last three years. Arteries have always been anastomosed end to end. The venous anastomoses have primarily been performed as end-to-side unions with the jugular vein. In nine patients, great distances between the donor and recipient vessel had to be connected with venous interponates. In two cases in which veins were lacking in the neck after radical neck dissection or radiation fibrosis, we used the cephalic vein or veins of the capsule of the thyroid gland as recipient vessels. The jejunal or osteomyocutaneous transplants were first fitted into the defect before performing the anastomosis. The jejunal peristalsis and the required freedom of movement in shaping the bone necessitated this technique. Microvascular anastomosis was first performed on the transplant of the radialis flap and the neurovascular infrahyoid muscular flap, and then they were integrated into the defect. We lost two transplants postoperatively because of venous thrombosis. In this article wie describe our anastomosis technique, the frequency distribution of recipient vessels, and the rules and characteristics of microvascular anastomosis after radiation and neck dissection.

  3. Reflections on dissection: leave no student behind.

    Science.gov (United States)

    Skandalakis, John E

    2008-01-01

    Dissection is being reduced--and even removed--from the medical curriculum in Australia, New Zealand, the United Kingdom, Ireland, and the United States. Dissection's contribution to the curriculum is too important to be diminished. To understand the human body, students must dissect. To avoid anatomical complications, future surgeons need the knowledge they can gain from dissection. Cadavers reveal the uniqueness of each body and the body's strength and fragility, which cannot be learned from books or computers. Cadavers offer surgical skill-building opportunities and confrontation with death. For all its strengths, however, dissection alone does not teach everything the student needs to know. Other educational tools (books, CT and MRI, animation of developmental processes) successfully fill in gaps of knowledge. Surgeons and educators must recognize the threat that decreased dissection poses to our students and patients. They must take steps to support dissection in the medical curriculum or, if it has disappeared, to bring it back.

  4. Acute spontaneous isolated dissection of abdominal aorta

    Directory of Open Access Journals (Sweden)

    Ali Akbar beigi

    2009-09-01

    Full Text Available

    • Aortic dissection occurs when the layers of the aorta separate as a result of extra luminal cavity of blood through an intimal tear. Dissection limited to the abdominal aorta is rare. Unfortunately, the appropriate management of dissecting aneurysm of abdominal aorta is not documented yet. A 43 years old man was admitted to Al-zahra hospital in Isfahan with sudden onset of periumbilical abdominal pain. CT scan confirmed infrarenal dissection of abdominal aorta. Performing laparotomy, aorta was repaired using bifurcate collagen-coated Dacron graft. Surgical intervention with synthetic graft is recommended in patients with dissecting aortic aneurysm of infrarenal segments where the extent of dissection is limited and accessible.
    • Keywords: Aneurysm, Aortic dissection, Aortic aneurysm abdominal surgery.

  5. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  6. Pediatric Neck Mass

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    Guilherme Machado de Carvalho

    2015-11-01

    Full Text Available Introduction  Neck masses include a wide variety of diagnostic possibilities, with more than 60 etiologies that depend on clinical aspects such as age, location and time of disease progression. The interview and physical examination guide research that cross the neck masses in pediatric patients in 3 groups: infectious / inflammatory, and neoplastic embryonic remnants. The aim of this study was to present a protocol for evaluation of neck masses in the pediatric age group, based on a review of literature on the subject and experience of this service. Materials and Methods Survey of literature data from PubMed / Medline, Google Scholar and Scopus Database without language restriction, since 1980 sources, with the MeSH term "Pediatric neck mass".  Results Prepared flowchart guidelines to be followed according with diagnostic suspicions. Patients were divided into 3 groups according to the initial clinical manifestations and according to etiological hypotheses formulated recommend evaluations protocols.  Conclusion The standardization of the evaluation of neck masses in children proves valuable and can help in the differential diagnosis of different etiologies involved.

  7. Noninvasive analysis of human neck muscle function

    Science.gov (United States)

    Conley, M. S.; Meyer, R. A.; Bloomberg, J. J.; Feeback, D. L.; Dudley, G. A.

    1995-01-01

    STUDY DESIGN. Muscle use evoked by exercise was determined by quantifying shifts in signal relaxation times of T2-weighted magnetic resonance images. Images were collected at rest and after exercise at each of two intensities (moderate and intense) for each of four head movements: 1) extension, 2) flexion, 3) rotation, and 4) lateral flexion. OBJECTIVE. This study examined the intensity and pattern of neck muscle use evoked by various movements of the head. The results will help elucidate the pathophysiology, and thus methods for treating disorders of the cervical musculoskeletal system. SUMMARY OF BACKGROUND DATA. Exercise-induced contrast shifts in T2 has been shown to indicate muscle use during the activity. The noninvasive nature of magnetic resonance imaging appears to make it an ideal approach for studying the function of the complex neuromuscular system of the neck. METHODS. The extent of T2 increase was examined to gauge how intensely nine different neck muscles or muscle pairs were used in seven subjects. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation was assessed to infer the pattern of use among and within individual neck muscles or muscle pairs. RESULTS. Signal relaxation increased with exercise intensity for each head movement. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation also increased with exercise load. Neck muscles or muscle pairs extensively used to perform each head movement were: extension--semispinalis capitis and cervicis and splenius capitis; flexion--sternocleidomastoid and longus capitis and colli; rotation--splenius capitis, levator scapulae, scalenus, semispinalis capitis ipsilateral to the rotation, and sternocleidomastoid contralateral; and lateral flexion--sternocleidomastoid CONCLUSION. The results of this study, in part, agree with the purported functions of neck muscles derived from anatomic location. This also was true for the few

  8. Cocaine mediated apoptosis of vascular cells as a mechanism for carotid artery dissection leading to ischemic stroke.

    Science.gov (United States)

    Dabbouseh, Noura M; Ardelt, Agnieszka

    2011-08-01

    In arterial dissection, blood may enter the arterial wall through an intimal tear, splitting the arterial wall and activating the coagulation cascade at the site of endothelial damage. Dissection of extracranial and intracranial vessels may lead to ischemic stroke through thromboembolic or hemodynamic mechanisms. Major blunt trauma or rapid acceleration-deceleration may cause dissection, but in patients with inherent arterial wall weakness, dissection can occur spontaneously or as a result of minor neck movement. Cocaine use has been associated with dissection of the aortic arch and coronary and renal arteries through cocaine-mediated hypertension. Recent preclinical studies have suggested, however, that cocaine may cause apoptosis of cells in the vascular wall. In this article, we postulate that cocaine may cause apoptosis of vascular endothelial and/or smooth muscle cells, thus weakening the vascular wall and resulting in a dissection-prone state. We review the literature and propose a biological basis for vasculopathy, vascular dissection, and ischemic stroke in the setting of cocaine use. Further research studies on vascular cells, as well as focused analysis of human pathological material, will be important in providing evidence for or against our hypotheses.

  9. A case series of 22 patients with internal carotid artery dissection

    Directory of Open Access Journals (Sweden)

    Jovanović Aleksandar

    2011-01-01

    Full Text Available The aim of this study was to analyze the spectrum of clinical presentations of internal carotid artery dissection. Twenty-two patients with internal carotid artery dissection, mean age 39.02, were evaluated over the past ten years. Magnetic resonance imaging and magnetic resonance angiography were used to establish the diagnosis. Facial and neck pain and Horner’s syndrome were the only presenting symptoms in 4 patients (without brain infarction; facial pain, Horner’s syndrome and contralateral sensorimotor deficit in 6; headache and contralateral sensorimotor deficit in 2; contralateral sensorimotor deficit with or without speech impairment in 10. Internal carotid artery dissection was triggered by a trauma in 7, whereas it was spontaneous in 15. Magnetic resonance imaging revealed infarction in 18 patients. A good outcome (modified Rankin score 0-2 was seen in 20 patients. The spectrum of clinical presentations of internal carotid artery dissection is variable. Internal carotid artery dissection is not necessarily accompanied by infarction on magnetic resonance imaging.

  10. Dissection of internal carotid artery presenting as isolated ischaemic optic neuropathy

    Directory of Open Access Journals (Sweden)

    Serdar Oruc

    2016-08-01

    Full Text Available Carotid artery dissections are one of the important reasons of cerebrovascular events that are observed before the age of 45. Besides the local findings such as head, neck and face pains, Horner syndrome findings, pulsatile tinnitus and cranial nerve involvements, some other symptoms such as ischemic stroke, transient ischemic attacks and amaurosis fugax can also be observed in the approximately three quarters of patients. Ischemic optic neuropathy may be seen as %4 in the carotid artery dissections and it mostly accompanies other ischemic local symptoms. It is rare to observe the ischemic optic neuropathy as the first and unique finding in the carotid artery dissections. In this study, a 55 year old male patient with carotid artery dissection was represented. He did not have any other complaint, except the sudden unilateral visual loss and he was sent to our clinics from the opthalmology clinics in order to search for the etiology of ischemic optic neuropathy. It should be kept in mind that there can be a possibility to have carotid artery dissections in patients with unilateral visual loss.

  11. Spontaneous coronary artery dissection: case report and literature review.

    Science.gov (United States)

    D'Ovidio, Cristian; Sablone, Sara; Carnevale, Aldo

    2015-05-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.

  12. Prognostic Value of p16 Status on the Development of a Complete Response in Involved Oropharynx Cancer Neck Nodes After Cisplatin-Based Chemoradiation: A Secondary Analysis of NRG Oncology RTOG 0129

    Science.gov (United States)

    Galloway, Thomas J.; Zhang, Qiang; Nguyen-Tan, Phuc Felix; Rosenthal, David I.; Soulieres, Denis; Fortin, André; Silverman, Craig L.; Daly, Megan E.; Ridge, John A.; Hammond, J. Alexander; Le, Quynh-Thu

    2016-01-01

    Purpose To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. Methods and Materials Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. Results Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n = 69; p16-negative: n = 30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P = .71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P = .42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P = .02) and was associated with a reduced incidence of local–regional failure (hazard ratio 0.33, P = .003). On multivariate analysis of local–regional failure, a test for interaction between pCR and p16 status was not significant (P = .37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P = .42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. Conclusions Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors. PMID:27478170

  13. Cervical range of movement in relation to neck dimension.

    Science.gov (United States)

    Reynolds, Jeremy; Marsh, D; Koller, Heiko; Zenenr, Juliane; Bannister, G

    2009-06-01

    The authors investigated the effect of neck dimension upon cervical range of motion. Data relating to 100 healthy subjects, aged between 20 and 40 years, were recorded with respect to age, gender and range of motion in three planes. Additionally, two widely used methods of measuring neck motion, chin-sternal distance and uniplanar goniometer, were assessed against a validated measurement tool, the 'CROM goniometer'. Using multiple linear regression analysis it was determined that sagittal flexion (P = 0.002) and lateral rotation (P cervical range of motion as outcome variable or as a measure at posttreatment follow-up, neck circumference was shown to be one of the factors influencing total neck motion, particularly sagittal flexion and lateral tilt. Comparison of cervical range of motion assessed with a validated measurement tool, the CROM goniometer, with results of both frequently applied clinician's instruments, the uniplanar goniometer and measurement of chin-sternal distance, showed low reliability with the latter techniques, and motion values measured with these techniques should be interpreted with caution if using them for comparison of cervical range of motion of alike groups. We demonstrated that neck dimension should be incorporated into cervical functional outcome assessment and one should be wary about recorded values for neck motion from non-validated measurement tools.

  14. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... oncologist will listen to the history of your problem and perform a physical examination. Consultations with other members of the head and neck team, such as the head and neck surgeon, pathologist, ...

  15. Lateral Mixing

    Science.gov (United States)

    2012-11-08

    being made on their analysis. A process we became very curious about was the separation of tendrils of warm salty water from the north wall figure 7...structure, and to remove the effect of internal waves by mapping this structure onto isopycnals. This has been very successful in elucidating lateral...we passed through the same water on multiple passes, and that changes in the horizontal structure of the water mas should be readily apparent from

  16. Huge Dissected Ascending Aorta Associated with Pseudo Aneurysm and Aortic Coarctation Feridoun

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available We report a unique case of chronic dissection of the ascending aorta complicated with huge and thrombotic pseudoaneurysm in a patient with coarctation of descending aorta. Preoperative investigations such as transesophageal echocardiography (TEE confirmed the diagnosis of dissection. Intraoperative findings included a12 cm eccentric bulge of the right lateral side of dilated the ascending aorta filled with the clot and a circular shaped intimal tear communicating with an extended hematoma and dissection of the media layer. The rarity of the report is an association of the chronic dissection with huge pseudoaneurysm and coarctation. The patient underwent staged repair of an aneurysm and coarctation and had an uneventful postoperative recovery period.

  17. A case report of missed femoral neck stress fracture

    Directory of Open Access Journals (Sweden)

    Onibere Oruaro Adebayo

    2015-01-01

    Full Text Available Femoral neck stress fracture (FNSF is an uncommon but potentially serious orthopaedic problem. This is a case report on missed femoral neck stress fracture in a 62-year-old female who was initially treated as early-onset coxarthrosis. She later presented to us with a displaced intra-capsular neck of left femur fracture and underwent total hip replacement. This case illustrates that causes other than osteoarthritis should be taken into consideration in patients presenting with anterior hip pain where symptoms are disproportionate to clinical and radiological findings. More advanced investigations such as MRI scan or regular follow up with plain radiographs should be performed. A delay in diagnosis can lead to secondary displacement of the femoral neck stress fracture.

  18. ASSESSMENT OF RELATIONSHIP BETWEEN NECK SHAFT ANGLE AND NECK LENGTH WITH INTEREPICONDYLAR DISTANCE IN FEMUR

    Directory of Open Access Journals (Sweden)

    Ishita Ghosh

    2015-12-01

    Full Text Available Background: Femur is the longest and strongest bone of the body. It transmits body weight from hip bone to tibia in standing position. Femoral neck is a constricted part connecting head with shaft at an angle of about 125°-known as angle of inclination or neck shaft angle (NSA; this facilitates the movement of hip joint enabling the limb to swing clear of pelvis. Abnormal femoral neck angle (FNA may be associated with various clinical problems ranging from harmless in toeing gait in childhood to disabling osteoarthritis in adults. The current study attempted to find out if a co-relation exists between those parameters and other clinically measurable variables like inter-epicondylar distance or distance between greater trochanter to lateral epicondyle. This may help to predict the risk of fracture neck femur without any risk of radiation exposure and proper prophylactic measures can be undertaken (Vit-D, calcium to decrease risk of fracture. Results: Measurements were taken in dry femora mostly in East Indian population. Variables that were measured in 158 dry femora (85 femora from left side and 73 from the right side are: - a Neck shaft angle of femur, b Neck length of femur, c Neck circumference of femur, d Inter-epicondylar distance of femur, e Distance between lateral epicondyle and greater trochanter of femur. No significant difference was found between the right and left sided femoral groups regarding any of the study variables. From the analysis it was revealed that no positive or negative correlation exists between the study variables. Therefore, it is not possible to predict the value of one or more of them from the magnitude of the other variable(s. Conclusions: Our study attempted to find out if it was possible to predict the risk of fracture neck femur by simple clinical procedure without exposing the subjects to radiation hazards associated with a radiological imaging. A screening test and subsequent prophylactic measures could

  19. LYMPHOCYTIC THYROIDITIS IS ASSOCIATED WITH INCREASED NUMBER OF BENIGN CERVICAL NODES AND FEWER CENTRAL NECK COMPARTMENT METASTATIC LYMPH NODES IN PATIENTS WITH DIFFERENTIATED THYROID CANCER.

    Science.gov (United States)

    Donangelo, Ines; Walts, Ann E; Bresee, Catherine; Braunstein, Glenn D

    2016-10-01

    Whether or not autoimmune thyroid disease influences the progression of differentiated thyroid cancer (DTC) remains controversial. Findings of previous studies are influenced by lead time bias and/or procedure bias selection. These biases can be reduced by studying a single-institution patient population that underwent a similar extent of surgical resection. From a cohort of 660 patients with DTC who underwent thyroidectomy, we retrospectively studied 357 patients who underwent total thyroidectomy and central compartment node dissection (CCND) for DTC between 2003 and 2013. Forty-one percent (140/345) of study patients had lymphocytic thyroiditis (LT), and 30% (91/301) had serum positive for thyroglobulin antibody (TgAb). LT was reported in 78% of the TgAb-positive cases. Sixty percent (213/357) of cases had metastatic thyroid carcinoma in 1 or more neck lymph nodes (55% [198/357] central compartment, and 22% [77/356] lateral compartment). Patients with LT had fewer metastatic cervical lymph nodes than those with no LT (2.7 ± 4.7 vs 3.5 ± 4.8, respectively, P = .0285). Patients with positive TgAb and thyroiditis had a larger number of benign cervical lymph nodes removed than those with negative TgAb or no LT. No significant difference was observed in age, tumor size, multifocality, extrathyroidal extension, vascular invasion, or frequency of cervical lymph node metastasis between TgAb-negative and -positive cases or between cases with and without LT. Lymphocytic thyroiditis is associated with fewer central neck compartment metastatic lymph nodes and a larger number of excised reactive benign cervical lymph nodes. Whether this association indicates a protective role of thyroid autoimmunity in lymph node spreading remains unclear. CCND = central compartment node dissection DTC = differentiated thyroid cancer HT = Hashimoto thyroiditis LT = lymphocytic thyroiditis TgAb = thyroglobulin antibody TPO = thyroid peroxidase.

  20. Lipoblastoma of the neck

    DEFF Research Database (Denmark)

    Lorenzen, Jacob C; Godballe, Christian; Kerndrup, Gitte B

    2005-01-01

    with lipoblastomatous tumours in the neck is presented. A 6-year-old boy with complains of stridorous respiration and significant reduction in physical capacity was referred to the ENT Department, Odense University Hospital, Denmark. He was treated with total surgical resection of a soft and slowly growing tumour...

  1. Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence.

    Science.gov (United States)

    Locketz, Garrett D; Lui, Justin T; Chan, Sonny; Salisbury, Kenneth; Dort, Joseph C; Youngblood, Patricia; Blevins, Nikolas H

    2017-06-01

    Objective To evaluate the effect of anatomy-specific virtual reality (VR) surgical rehearsal on surgeon confidence and temporal bone dissection performance. Study Design Prospective pre- and poststudy of a novel virtual surgical rehearsal platform. Setting Academic otolaryngology-head and neck surgery residency training programs. Subjects and Methods Sixteen otolaryngology-head and neck surgery residents from 2 North American training institutions were recruited. Surveys were administered to assess subjects' baseline confidence in performing 12 subtasks of cortical mastoidectomy with facial recess. A cadaver temporal bone was randomly assigned to each subject. Cadaver specimens were scanned with a clinical computed tomography protocol, allowing the creation of anatomy-specific models for use in a VR surgical rehearsal platform. Subjects then rehearsed a virtual mastoidectomy on data sets derived from their specimens. Surgical confidence surveys were administered again. Subjects then dissected assigned cadaver specimens, which were blindly graded with a modified Welling scale. A final survey assessed the perceived utility of rehearsal on dissection performance. Results Of 16 subjects, 14 (87.5%) reported a significant increase in overall confidence after conducting an anatomy-specific VR rehearsal. A significant correlation existed between perceived utility of rehearsal and confidence improvement. The effect of rehearsal on confidence was dependent on trainee experience and the inherent difficulty of the surgical subtask. Postrehearsal confidence correlated strongly with graded dissection performance. Subjects rated anatomy-specific rehearsal as having a moderate to high contribution to their dissection performance. Conclusion Anatomy-specific virtual rehearsal improves surgeon confidence in performing mastoid dissection, dependent on surgeon experience and task difficulty. The subjective confidence gained through rehearsal correlates positively with subsequent

  2. 空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折%Cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures

    Institute of Scientific and Technical Information of China (English)

    周炎; 刘世清; 瞿新丛; 廖琦; 余铃; 黄涛

    2014-01-01

    目的 探讨空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折的手术方法及临床疗效. 方法 2008年3月至2011年6月,对收治的12例距骨颈骨折采用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗.术后非负重功能位外固定12~14周,并根据X线片显示骨折愈合情况确定负重时间.末次随访时根据美国足与踝关节外科协会踝与后足功能评分系统评价术后功能. 结果 12例术后随访12 ~ 48个月,平均24个月.1例出现切口皮缘坏死,经换药处理后愈合.距骨颈骨折均获愈合,愈合时间为16~ 24周,平均20周.末次随访时AOFAS踝与后足功能评分为55~ 96分,平均82.5分,其中优4例,良5例,可3例.2例发生距下关节轻度创伤性关节炎,口服消炎镇痛药后疼痛缓解;1例发生距骨体缺血性坏死,X线片显示距骨体骨质硬化,但未塌陷,嘱患者减少负重并定期随访观察. 结论 应用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折,能改善距骨体血供,降低距骨缺血性坏死的发生,是有效的治疗手段.%Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures.Methods From March 2008 to June 2011,12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery.External fixation in functional position for 12-14 weeks,and the load time was determined by X-ray fracture healing.Functional results were assessed according to AOFAS (American Orthopaedic Foot and Ankle Society) score at last follow-up.Results Twelve cases were followed up for an average of 24 months (12 to 48 months).One case of skin flap necrosis healed by dressing.All the fractures healed

  3. Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

    Science.gov (United States)

    Stanisic, M; Winckiewicz, M; Juszkat, R; Gabriel, M; Jawien, A; Staniszewski, R

    2009-08-01

    Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.

  4. Developmental biomechanics of neck musculature

    OpenAIRE

    Lavallee, Amy V.; Ching, Randal P.; Nuckley, David J.

    2012-01-01

    Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A fa...

  5. Spontaneous Cervical Artery Dissection: The Borgess Classification

    Directory of Open Access Journals (Sweden)

    Firas eAl-Ali

    2013-09-01

    Full Text Available ABSTRACTBackground and Purpose: The pathogenesis of spontaneous cervical artery dissections (sCAD and its best medical treatment are debated. This may be due to a lack of clear classification of sCAD. We propose the new Borgess classification of sCAD, based on the presence or absence of intimal tear as depicted on imaging studies and effect on blood flow. Materials and Methods: This is a single-center investigator-initiated registry on consecutive patients treated for sCAD. In the Borgess classification, type I dissections have intact intima and type II dissections have an intimal tear. Results: Forty-four patients and 52 dissected arteries were found. Forty-nine of 52 dissections (93% were treated with dual anti-platelet therapy. Twenty-one of 52 dissections were type I; 31 were type II. Type I dissections were more likely to present with ischemic symptoms (stroke, TIA (p=0.001. More type I dissections occurred in the vertebral artery, while more type II dissections occurred in the internal carotid artery (p

  6. Evolution of neck vertebral shape and neck retraction at the transition to modern turtles: an integrated geometric morphometric approach.

    Science.gov (United States)

    Werneburg, Ingmar; Wilson, Laura A B; Parr, William C H; Joyce, Walter G

    2015-03-01

    The unique ability of modern turtles to retract their head and neck into the shell through a side-necked (pleurodiran) or hidden-necked (cryptodiran) motion is thought to have evolved independently in crown turtles. The anatomical changes that led to the vertebral shapes of modern turtles, however, are still poorly understood. Here we present comprehensive geometric morphometric analyses that trace turtle vertebral evolution and reconstruct disparity across phylogeny. Disparity of vertebral shape was high at the dawn of turtle evolution and decreased after the modern groups evolved, reflecting a stabilization of morphotypes that correspond to the two retraction modes. Stem turtles, which had a very simple mode of retraction, the lateral head tuck, show increasing flexibility of the neck through evolution towards a pleurodiran-like morphotype. The latter was the precondition for evolving pleurodiran and cryptodiran vertebrae. There is no correlation between the construction of formed articulations in the cervical centra and neck mobility. An increasing mobility between vertebrae, associated with changes in vertebral shape, resulted in a more advanced ability to retract the neck. In this regard, we hypothesize that the lateral tucking retraction of stem turtles was not only the precondition for pleurodiran but also of cryptodiran retraction. For the former, a kink in the middle third of the neck needed to be acquired, whereas for the latter modification was necessary between the eighth cervical vertebra and first thoracic vertebra. Our paper highlights the utility of 3D shape data, analyzed in a phylogenetic framework, to examine the magnitude and mode of evolutionary modifications to vertebral morphology. By reconstructing and visualizing ancestral anatomical shapes, we provide insight into the anatomical features underlying neck retraction mode, which is a salient component of extant turtle classification. © The Author(s) 2014. Published by Oxford University Press

  7. Concurrent chemoradiation for unresectable advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Wakako; Ogino, Takashi; Ishikura, Satoshi [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East] [and others

    1998-03-01

    Concurrent chemoradiotherapy were performed for 18 patients with unresectable head and neck squamous cell cancer. Chemotherapy, consisting of CDDP (40 mg/m{sup 2}, Day 1 and 8) and 5-FU (200 mg/m{sup 2}, 24-h continuous infusion through Day 1-5 and 8-12), with concurrent radiotherapy (2 Gy/day, 5 days/w) were administered and repeated 2-3 courses in every 5 weeks. Mucositis and myelo-suppression were the main side effects observed, but all of them were tolerable. Total response rate and complete response rate was 94.4% and 55.6%, respectively. Out of six patients requiring tracheotomy for airway obstruction due to bulky tumor, four achieved sufficient tumor shrinkage by the treatment and could obtain closure of the stoma. Two patients whose neck lymph nodes were still remaining after chemoradiotherapy, could obtain local control by supplemental neck dissection surgery. These regimen is feasible and effective for locally advanced head and neck cancer. (author)

  8. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    Science.gov (United States)

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

  9. Posterolateral supporting structures of the knee: findings on anatomic dissection, anatomic slices and MR images

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, M. de; Shahabpour, M.; Vanderdood, K.; Ridder, F. de; Osteaux, M. [Dept. of Radiology, Free Univ. Brussels (Belgium); Roy, F. van [Dept. of Experimental Anatomy, Free Univ. Brussels (Belgium)

    2001-11-01

    In this article we study the ligaments and tendons of the posterolateral corner of the knee by anatomic dissection, MR-anatomic correlation, and MR imaging. The posterolateral aspect of two fresh cadaveric knee specimens was dissected. The MR-anatomic correlation was performed in three other specimens. The MR images of 122 patients were reviewed and assessed for the visualization of different posterolateral structures. Anatomic dissection and MR-anatomic correlation demonstrated the lateral collateral, fabellofibular, and arcuate ligaments, as well as the biceps and popliteus tendons. On MR images of patients the lateral collateral ligament was depicted in all cases. The fabellofibular, arcuate, and popliteofibular ligaments were visualized in 33, 25, and 38% of patients, respectively. Magnetic resonance imaging allows a detailed appreciation of the posterolateral corner of the knee. (orig.)

  10. Progressive Bilateral Vertebral Artery Dissection in a Case of Osteogenesis Imperfecta.

    Science.gov (United States)

    Kato, Yuji; Nagoya, Harumitsu; Abe, Tetsuya; Hayashi, Takeshi; Yasuda, Masanori; Uchino, Akira; Tanahashi, Norio; Takao, Masaki

    2017-03-01

    A 32-year-old woman with osteogenesis imperfecta (OI) was admitted to the hospital because of a right-sided occipital headache and facial paresthesia. She was diagnosed with lateral medullary syndrome due to right vertebral artery (VA) dissection. She was treated conservatively without antithrombotic therapy. She developed subarachnoid hemorrhage because of contralateral VA dissection 18 days later. This clinical course may reflect the underlying weakness of the vessel wall in OI. In patients with OI, occlusion of a unilateral VA could cause dissection and subsequent rupture of the contralateral VA. Early surgical treatment for lesions of the VA is required in such cases. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Evaluation of Educator & Student Use of & Attitudes toward Dissection & Dissection Alternatives

    Science.gov (United States)

    Osenkowski, Pamela; Green, Che; Tjaden, Anne; Cunniff, Peggy

    2015-01-01

    Animal dissection has been routinely practiced in American biology classrooms for decades. With technological advancements, more states adopting student choice measures, and increased awareness about ethical concerns surrounding dissection, many useful dissection alternatives have been developed. To understand the current use of animal dissection…

  12. Evaluation of Educator & Student Use of & Attitudes toward Dissection & Dissection Alternatives

    Science.gov (United States)

    Osenkowski, Pamela; Green, Che; Tjaden, Anne; Cunniff, Peggy

    2015-01-01

    Animal dissection has been routinely practiced in American biology classrooms for decades. With technological advancements, more states adopting student choice measures, and increased awareness about ethical concerns surrounding dissection, many useful dissection alternatives have been developed. To understand the current use of animal dissection…

  13. Type A aortic dissection complicated by an aorto-right atrial fistula.

    Science.gov (United States)

    Sytnik, Peter; White, Christopher W; Nates, Wayne; Lytwyn, Matthew; Strumpher, Johann; Arora, Rakesh C; Freed, Darren H

    2015-02-01

    A 63-year-old male underwent an ascending aortic replacement for an acute type A dissection. Nine days later a fistulous communication between the right coronary sinus and right atrium was identified and surgically repaired. We present a literature review, including the clinical presentation, diagnosis, and surgical management of this rare complication.

  14. Preferred neck-resting position predicts aggression in Caribbean flamingos (Phoenicopterus ruber).

    Science.gov (United States)

    Anderson, Matthew J; Williams, Sarah A; Bono, Amanda J

    2010-11-01

    When flamingos rest, they typically lay their heads along their backs. In order to achieve this positioning they curve their necks to either the right or left of their midline. Previously we have shown both individual and flock-level laterality of preferred neck-resting direction, with most birds preferring to rest their necks to their right (Anderson, Williams, & O'Brien, 2009). As laterality has been shown to play a role in social cohesion (e.g., Rogers & Workman, 1989) and aggression (e.g., Vallortigara, Cozzutti, Tommasi, & Rogers, 2001), here we attempted to determine whether a flamingo's preferred neck-resting direction could be used to predict involvement in aggressive encounters. Results replicated the earlier flock-level preference for neck resting towards the right, and indicated that those flamingos preferring the left were more likely to be involved in aggressive encounters.

  15. WorldSID Dummy Head-Neck Biofidelity Response.

    Science.gov (United States)

    Been, Bernard; Philippens, Mat; de Lange, Ronald; van Ratingen, Michiel

    2004-11-01

    Accident studies indicate that serious neck injuries are generally infrequent in side crashes. However, given the rapid changes in side impact protection technology, such as side airbags and curtain systems, the nature of head-neck interactions is likely to change. Consequently, the newest generation of anthropomorphic test devices for side impact should provide realistic prediction of the head-neck kinematics and include meaningful measurements related to risk of head and neck injury. The WorldSID dummy has been assessed against a set of five test conditions that have been used to define biofidelity impact response targets. Three of the five test conditions are recommended by ISO TR9790 (ISO 1997), the NBDL 7.2 G, 6.9 m/s lateral sled impact reported by Ewing et al. (1977) and Wismans et al. (1986) , the Patrick and Chou lateral, 6.7 G 5.8 m/s (1976) and Tarriere lateral 12.2 g, 6,1 m/s sled impact (ISO 1997). Due to its expected loading environment, the dummy neck performance has also been evaluated for neck bending in frontal flexion and extension (Mertz and Patrick, 1971). The 5th test condition is the NBDL 45 degrees frontal-oblique sled test (Wismans 1986, Philippens 2004). The latter and two of the ISO TR9790 test conditions form the basis of the draft IHRA requirements for evaluating side impact dummy biomechanical responses. The paper reports on the findings of the assessment of the WorldSID pre-production dummy. The Mertz and Patrick OC moment-head angle corridor is used as supplemental requirement for frontal flexion-extension. The biofidelity requirements contain both kinematic and dynamic response targets. The neck has a good performance for NBDL lateral and Tarriere requirements, and the Mertz OC moment-flexion angle. The performance for the Patrick and Chou, the NBDL oblique test conditions and the Mertz OC moment extension angle are fair to marginal. The repeatability performance of the dummy was found to be good for all lateral and most oblique

  16. [Internal carotid artery dissection after Heimlich maneuver].

    Science.gov (United States)

    Rakotoharinandrasana, H; Petit, E; Dumas, P; Vandermarcq, P; Gil, R; Neau, J-Ph

    2003-01-01

    We report a case of cervical artery dissection following a Heimlich maneuver. Cervical artery dissections are at the present time well known and are sometimes associated with trivial traumas. However, to our knowledge, this complication of such maneuver was never reported in the literature. Pathophysiological mechanisms are discussed.

  17. Quick Dissection of the Segmental Bronchi

    Science.gov (United States)

    Nakajima, Yuji

    2010-01-01

    Knowledge of the three-dimensional anatomy of the bronchopulmonary segments is essential for respiratory medicine. This report describes a quick guide for dissecting the segmental bronchi in formaldehyde-fixed human material. All segmental bronchi are easy to dissect, and thus, this exercise will help medical students to better understand the…

  18. Keeping Dissection Alive for Medical Students

    Science.gov (United States)

    Chambers, James; Emlyn-Jones, Daniel

    2009-01-01

    Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host…

  19. Keeping Dissection Alive for Medical Students

    Science.gov (United States)

    Chambers, James; Emlyn-Jones, Daniel

    2009-01-01

    Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host…

  20. Role of culture of postoperative drainage fluid in the prediction of infection of the surgical site after major oncological operations of the head and neck.

    Science.gov (United States)

    Candau-Alvarez, A; Linares-Sicilia, M J; Dean-Ferrer, A; Pérez-Navero, J L

    2015-02-01

    Infection of the surgical site after major oncological operations of the head and neck increases mortality and morbidity. The aim of this prospective pilot study was to assess the efficacy of culturing the exudate from the drain after cervical neck dissection to see if it predicted such infection. We studied 40/112 patients with squamous cell cancer of the head and neck who were treated during the last two years and met our inclusion criteria. Six patients developed infections (15%). Reconstruction with pedicled rather than local or microvascular flaps, duration of operation of over 7 hours, the presence of a tracheostomy, and bilateral neck dissection were considered risk factors (p=0.01). Culture of drainage fluid on postoperative day 3 that grew no pathogens predicted that the site would not become infected, with a negative predictive value of 96%. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Modeling plaque fissuring and dissection during balloon angioplasty intervention.

    Science.gov (United States)

    Gasser, T Christian; Holzapfel, Gerhard A

    2007-05-01

    Balloon angioplasty intervention is traumatic to arterial tissue. Fracture mechanisms such as plaque fissuring and/or dissection occur and constitute major contributions to the lumen enlargement. However, these types of mechanically-based traumatization of arterial tissue are also contributing factors to both acute procedural complications and chronic restenosis of the treatment site. We propose physical and finite element models, which are generally useable to trace fissuring and/or dissection in atherosclerotic plaques during balloon angioplasty interventions. The arterial wall is described as an anisotropic, heterogeneous, highly deformable, nearly incompressible body, whereas tissue failure is captured by a strong discontinuity kinematics and a novel cohesive zone model. The numerical implementation is based on the partition of unity finite element method and the interface element method. The later is used to link together meshes of the different tissue components. The balloon angioplasty-based failure mechanisms are numerically studied in 3D by means of an atherosclerotic-prone human external iliac artery, with a type V lesion. Image-based 3D geometry is generated and tissue-specific material properties are considered. Numerical results show that in a primary phase the plaque fissures at both shoulders of the fibrous cap and stops at the lamina elastica interna. In a secondary phase, local dissections between the intima and the media develop at the fibrous cap location with the smallest thickness. The predicted results indicate that plaque fissuring and dissection cause localized mechanical trauma, but prevent the main portion of the stenosis from high stress, and hence from continuous tissue damage.

  2. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    Science.gov (United States)

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  3. Dermatomal sensory manifestations in lateral medullary infarction.

    Science.gov (United States)

    Hongo, Hiroki; Tanaka, Yasutaka; Shimada, Yoshiaki; Tanaka, Ryota; Hattori, Nobutaka; Urabe, Takao

    2014-01-01

    A 61-year-old man who experienced a sudden onset of unstable gait followed by nuchal pain was admitted to our department. The neurologic examination revealed right-sided limb ataxia, right partial ptosis, and decreased sensation to 50% of the normal side to pinprick and temperature stimuli on the left side below the level of the T-6 dermatome. A lateral medullary infarction caused by spontaneous vertebral artery dissection was diagnosed by magnetic resonance imaging and computed tomography angiography. In conclusion, lateral medullary infarction is an important entity to consider in the differential diagnosis of dermatomal sensory manifestations.

  4. Internal carotid dissection caused by an elongated styloid process (Eagle syndrome).

    Science.gov (United States)

    Sveinsson, Olafur; Kostulas, Nikolaos; Herrman, Lars

    2013-06-11

    Eagle syndrome (symptoms associated with an elongated styloid process (SP)) is commonly divided into two presentations. First, the so-called classic Eagle syndrome where patients can present with unilateral sore throat, dysphagia, tinnitus, unilateral facial and neck pain and otalgia. Second, there is the vascular or stylocarotid form of Eagle syndrome in which the elongated SP is in contact with the extracranial internal carotid artery. We describe two cases of internal carotid artery dissection associated with an elongated SP. One is a patient with ischaemic stroke and another with transient ischaemic attacks caused by an elongated SP. A surgical resection of the SP was performed on the former patient. Both patients were treated with anticoagulation and recovered well. A literature search only revealed two prior descriptions of carotid dissection in the context of an elongated SP.

  5. Should we abandon cervical spine manipulation for mechanical neck pain? : yes

    OpenAIRE

    2012-01-01

    Cervical spine manipulation (a high velocity, low amplitude, end range thrust manoeuvre) is a common\\ud treatment option for mechanical neck pain yet may carry the potential for serious neurovascular\\ud complications, specifically vertebral artery dissection and subsequent vertebrobasilar stroke. The nonsuperiority\\ud of manipulation to alternative treatments, coupled with concerns regarding safety, renders\\ud cervical spine manipulation unnecessary and inadvisable.

  6. Quantification of Femoral Neck Exposure Through a Minimally Invasive Smith-Petersen Approach

    Science.gov (United States)

    2010-06-01

    2004; 429:248 255. 9. Jacobs MA, Goytia RN, Bhargava T. Hip resurfacing through an anterolateral approach: surgical description and early review. J...neck blood supply than the posterior approach during hip resurfacing . J Bone Joint Surg (Br). 2007;89-B: 1293 1298. 11. Swiontkowski MF, Thorpe M, Seiler...approach to the hip . Methods: Ten fresh frozen hemipelves were dissected using a minimally invasive Smith Petersen approach. Upon completion of the

  7. Neck pain in different cephalalgias

    OpenAIRE

    E. A. Chechet; G. R. Tabeeva

    2014-01-01

    The paper reviews the literature related to the investigations of neck pain (cervicalgia) in patients with headache (cephalalgia). Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cer...

  8. Factors affecting results of lymph node dissection in patients with skin Melanoma, 1987-92

    Directory of Open Access Journals (Sweden)

    Mir M

    1998-08-01

    Full Text Available In this paper, factors affecting the result of prophylactic lymph node dissection in 125 patients with skin melanoma during the period between 1987-1992 in the cancer institute were evaluated and prognostic parameters ascertained. The result showed prevalence of head and neck melanoma in men were two times more than in women with a preponderance of regional and lymphatic recurrence. Majority of patients presented with advanced clark levels (76.8 Pct. Clinical and histologic evaluation of the regional lymph nodes failed to show any meaningful relation.

  9. Aortic Dissection Type A in Alpine Skiers

    Science.gov (United States)

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  10. [A case of primary coronary artery dissection].

    Science.gov (United States)

    Nishino, M; Kato, J; Ezumi, A; Nozaki, S; Nishino, Y; Tanahashi, H; Yasuno, M; Kobayashi, K; Yamada, Y; Abe, H

    1990-06-01

    Primary coronary artery dissection occurring as a spontaneous event and not associated with trauma due to catheter manipulation is rare. We recently experienced (a case of) a 52-year-old man with primary artery dissection. He was admitted to our hospital with severe chest pain as his chief complaint on September 6, 1988. Electrocardiography and laboratory data showed acute inferior myocardial infarction. He was treated with medication and underwent coronary angiograms on October 3, 1988. Right coronary angiogram revealed an intimal flap and false lumen. But right coronary angiograms 6 months after the onset of myocardial infarction revealed progression of stenosis but no intimal flap, and coronary spasm was not evoked after acetylcholine administration. Primary coronary artery dissection has been reported since Pretty's first description of it in 1931. The majority of earlier cases were diagnosed at autopsy, but recently reports of survivors have been increasing due to the progress in and popularization of coronary angiographic technics. This case is the 46th case of primary coronary dissection found by coronary angiography. So it is not extremely rare. In our case the involved artery was the right coronary artery. In survivors, right coronary artery dissection is more frequent than left, because the area supplied by the right coronary artery is smaller than the area supplied by the left one. Although in our case coronary artery stenosis progressed, after a long term resolution of dissection may occur. There are a few cases in which resolution of dissection occurred naturally.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Assessment of preoperative ultrasonography of the neck and elective neck dissection in patients with oral squamous cell carcinoma.

    NARCIS (Netherlands)

    Wensing, B.M.; Merkx, M.A.W.; Wilde, P.C.M. de; Marres, H.A.M.; Hoogen, F.J.A. van den

    2010-01-01

    Estimating the value of our preoperative workup in the treatment of patients with clinically N0 (cN0) squamous cell carcinoma of the oral cavity. Retrospective analysis. Results of preoperative palpation, ultrasound (US) and ultrasound-guided fine needle aspiration cytology (FNAC) were compared to t

  12. Interventional radiology neck procedures.

    Science.gov (United States)

    Zabala Landa, R M; Korta Gómez, I; Del Cura Rodríguez, J L

    2016-05-01

    Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

  13. Aggressive Fibromatosis in Neck.

    Directory of Open Access Journals (Sweden)

    Namita Kabdwal

    2013-01-01

    Full Text Available Aggressive fibromatosis (AF is a locally aggressive infiltrative low-grade benign tumor that accounts for approximately less than 3% of all soft tissue tumors. In the head and neck region this tumor tends to be more aggressive and associated with significant morbidity. Aggressive surgery is a viable management option and may be successfully used as a single modality treatment, or in combination with radiotherapy. We report a rare case of AF in a 38 year old female, who presented with a painless mass over the left supraclavicular fossa, extending inferiorly into the thoracic inlet, which was excised successfully in toto with the help of cardiothoracic vascular surgeon (CTVS.

  14. Cervical artery dissection: trauma and other potential mechanical trigger events.

    Science.gov (United States)

    Engelter, Stefan T; Grond-Ginsbach, Caspar; Metso, Tiina M; Metso, Antti J; Kloss, Manja; Debette, Stephanie; Leys, Didier; Grau, Armin; Dallongeville, Jean; Bodenant, Marie; Samson, Yves; Caso, Valeria; Pezzini, Alessandro; Bonati, Leo H; Thijs, Vincent; Gensicke, Henrik; Martin, Juan J; Bersano, Anna; Touzé, Emmanuel; Tatlisumak, Turgut; Lyrer, Philippe A; Brandt, Tobias

    2013-05-21

    To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD). In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non-CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated. We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non-CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%-44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non-CeAD-IS patients (ORcrude 5.6 [95% CI 4.20-7.37], p < 0.001; ORadjusted 7.6 [95% CI 5.60-10.20], p < 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03-3.68], p < 0.001; ORadjusted 3.7 [95% CI 2.40-5.56], p < 0.001). CeAD patients with PCT were younger and presented more often with neck pain and less often with stroke than CeAD patients without PCT. PCT was not associated with functional 3-month outcome after adjustment for age, sex, and stroke severity. PCT seems to be an important environmental determinant of CeAD, but was not an independent outcome predictor. Because of the characteristics of most PCTs, the term mechanical trigger event rather than trauma may be more appropriate.

  15. CT angiography - head and neck

    Science.gov (United States)

    ... often on the face or scalp Swallowing problems Stroke Transient ischemic attack (TIA) Weakness in one part of your body CTA of the neck may also be done: After trauma to the neck to look for damage to blood vessels For planning before carotid artery ...

  16. Biogeometry of femoral neck for implant placement

    Directory of Open Access Journals (Sweden)

    Patwa J

    2006-01-01

    Full Text Available Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck and vernier caliper (dry cadeveric neck in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

  17. Unknown primary cancer of the head and neck: a multidisciplinary approach.

    Science.gov (United States)

    Cerezo, Laura; Raboso, Eduardo; Ballesteros, Ana Isabel

    2011-02-01

    The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.

  18. Type B Aortic Dissection: Management Updates

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2009-12-01

    Full Text Available Acute aortic dissection (AAD is the most frequent catastrophic event of the aorta; it occurs nearly three times as frequently as the rupture of abdominal aortic aneurysm. Sixty percent of dissection cases are classified as proximal or type A and 40% as distal or type B, according to the Stanford Classification. The most frequent causes of death in acute type B dissection are aortic rupture and malperfusion syndrome.We herein review recent data suggesting different management modalities of type B aortic dissection, including medical, surgical, and endovascular treatments. Although medical therapy is still the standard approach in uncomplicated cases, there are subgroups of patients who may benefit from endovascular management. Endovascular techniques or surgery are valuable options for complicated cases. Hybrid suites, multidisciplinary approaches, and good imaging techniques can be considered as the key to success in this regard.

  19. Migraine and vertebrobasilar dissection: Case reports.

    Science.gov (United States)

    Yenari, M A; Steinberg, G K; Marks, M P

    1994-01-01

    We report two patients with chronic migraine headaches who developed vertebrobasilar arterial dissections. In both cases, there was a change in both the character and location of the headaches, which prompted further evaluation with magnetic resonance imaging and angiography, which led to the diagnosis. Other possible risk factors for dissection in these patients included hypertension, exercise, and chiropractic manipulation. Both patients were treated with anticoagulation and recovered with little to no neurologic deficit. A review of the literature relating migraine and arterial dissection suggests that there may be an association. Although more extensive controlled studies are needed to demonstrate the significance of this association, we suggest that the diagnosis of cervicocranial arterial dissection be strongly considered in migraine patients who develop an abrupt change in the nature of their headaches. Copyright © 1994 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Laparoscopic anatomy and dissection of the pelvis.

    Science.gov (United States)

    Kadar, N

    1997-03-01

    All anatomically important pelvic structures lie embedded in the fatty-fibrous connective tissue of the retroperitoneum from which they can be freed by blunt dissection in the correct tissue planes. By relying on fixed laparoscopic landmarks, the correct surgical planes of dissection can be found, and all vital structures freed and identified by a systematic dissection consisting of a precise sequence of operative steps. Once the retroperitoneal dissection has been completed and all vital structures identified, most gynaecological operations can be carried out safely and without much difficulty laparoscopically. A non-anatomical approach to laparoscopic pelvic surgery may be easier to learn, but it is neither very versatile nor very safe except in the simplest of cases.

  1. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  2. Extended lymph node dissection for prostate cancer.

    Science.gov (United States)

    Jeschke, Stephan; Burkhard, Fiona C; Thurairaja, Ramesh; Dhar, Nivedita; Studer, Urs E

    2008-05-01

    Lymph node status is an important determinant for the management of patients with newly diagnosed prostate cancer. Given the significant limitations of cross-sectional and functional preoperative imaging in the detection of small metastases, pelvic lymph node dissection remains the only reliable staging method in clinically localized prostate cancer. Although lymph node dissection is a well-established form of staging in prostate cancer, controversy remains about indications and the surgical extent of the procedure. Reported practices vary from omitting pelvic lymph node dissection in low-risk disease to routine pelvic lymph node dissection in all radical prostatectomy patients. This review highlights the recent literature concerning pelvic lymphadenectomy in prostate cancer with respect to anatomical extent and oncologic outcome.

  3. Animal Rights Groups Target High School Dissection.

    Science.gov (United States)

    Trotter, Andrew

    1992-01-01

    Two groups leading the charge against dissection are People for the Ethical Treatment of Animals (PETA) and the Student Action Corps for Animals (SACA). Protests by student and community members remain the movement's strongest weapon. (MLF)

  4. [Gross anatomy dissection and the legal control].

    Science.gov (United States)

    Yamashina, Shohei; Shibata, Yosaburo

    2010-12-01

    In Japan, dissection of human body is generally prohibited by the Penal Code, i.e. the criminal law. However, the Postmortem Examination and Corpse Preservation Act allows for the dissection of the body in very limited situations, that include gross anatomy dissection and pathological and forensic autopsy in medical and dental schools. Growing numbers of co-medical schools have been founded more recently in Japan, and not a small number of co-medical schools try to adopt human body dissection in the course of anatomy education. The present short communication reminds us of the ways of thinking of the Postmortem Examination and Corpse Preservation Act and the Act on Body Donation for Medical and Dental Education in order that anatomy education in medical as well as co-medical schools takes place under the regulation by these two laws.

  5. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

    2012-01-15

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  6. Neck pain causes respiratory dysfunction.

    Science.gov (United States)

    Kapreli, Eleni; Vourazanis, Evangelos; Strimpakos, Nikolaos

    2008-01-01

    This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.

  7. Value of MR and CT Imaging for Assessment of Internal Carotid Artery Encasement in Head and Neck Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    W. L. Lodder

    2013-01-01

    Full Text Available Objective. This study was conducted to assess the value of CT and MR imaging in the preoperative evaluation of ICA encasement. Methods. Based upon three patient groups this study was performed. Retrospective analysis of 260 neck dissection reports from 2001 to 2010 was performed to determine unexpected peroperative-diagnosed encasement. Two experienced head and neck radiologists reviewed 12 scans for encasement. Results. In four out of 260 (1.5% patients undergoing neck dissection, preoperative imaging was false negative as there was peroperative encasement of the ICA. Of 380 patients undergoing preoperative imaging, the radiologist reported encasement of the ICA in 25 cases. In 342 cases no encasement was described, 125 of these underwent neck dissection, and 2 had encasement peroperatively. The interobserver variation kappa varied from 0.273 to 1 for the different characteristics studied. Conclusion. These retrospectively studied cohorts demonstrate that preoperative assessment of encasement of the ICA using MRI and/or CT was of value in evaluation of ICA encasement and therefore contributively in selecting operable patients (without ICA encasement, since in only 1.5% encasement was missed. However, observer variation affects the reliability of this feature.

  8. Aortic Dissection Cases Presenting with Neurological Deficit

    Directory of Open Access Journals (Sweden)

    Sibel Mumcu

    2014-06-01

    Full Text Available Aortic dissection can be fatal in case of underdiagnosis, and early treatment is essential for the survival. Although acute onset of chest or back pain is most common presenting symptoms, some patients might present with atypical findings such as acute stroke, mesenteric ischaemia, renal failure or myocardial infarction. Here, we report two cases presenting emergency room with atypical findings of aortic dissection which diagnosis is made during etiologic work up for ischemic stroke.

  9. Validation of the pathological classification of lymph node metastasis for head and neck tumors according to the 8th edition of the TNM Classification of Malignant Tumors.

    Science.gov (United States)

    García, Jacinto; López, Montserrat; López, Laura; Bagué, Silvia; Granell, Esther; Quer, Miquel; León, Xavier

    2017-07-01

    One of the main changes in the 8th edition of the TNM Classification for head and neck tumors is the inclusion of extracapsular spread (ECS) as a criterion for evaluating the regional extension, both clinical (cN) and pathological (pN). The objective of our study is to evaluate the prognostic capacity derived from the inclusion of the ECS in the pathological classification of head and neck squamous cell carcinoma (HNSCC) patients treated with a neck dissection, as established by the 8th edition TNM Classification. Retrospective study of 1188 patients with HNSCC treated with a neck dissection between1990 and 2013. There were lymph node metastasis in 50.1% of the neck dissections. The pathological record revealed ECS in 50.5% of the positive neck dissections. The implementation of the changes of the 8th edition TNM classification produced the upstaging of 20.9% of the patients classified as pN1 with the 7th edition TNM classification to pN2a¸ and the upstaging of 58.4% of the patients classified as pN2 with the 7th edition TNM classification to pN3b. We conducted an objective comparison of the quality of both classifications. The 8th TNM classification edition achieved better results regarding both the discrimination in cause-specific survival between pN categories and in the distribution in the number of cases between categories than the 7th edition TNM classification. The inclusion of ECS in the pathological classification (pN) of the neck nodes improves the prognostic capacity of the 8th TNM Classification edition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Nodular Hyperplasia Arising from the Lateral Aberrant Thyroid Tissue: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Min Hye; Park, Jeong Seon; Lee, Young Jun [Dept. of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul (Korea, Republic of)

    2012-06-15

    The presence of aberrant thyroid tissue in the lateral neck is very rare. In addition, nodular hyperplasia in ectopic thyroid has rarely been reported. Due to the unusual location, the presence of lateral aberrant thyroid tissue could be misdiagnosed as a lymphadenopathy, neurogenic tumor, etc. We report on a case of nodular hyperplasia arising from the right lateral aberrant thyroid tissue.

  11. The effects of dissection-room experiences and related coping strategies among Hungarian medical students.

    Science.gov (United States)

    Sándor, Imola; Birkás, Emma; Győrffy, Zsuzsa

    2015-04-11

    Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems. Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping. Fifty per cent of students stated that the dissection experience does not affect them. Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study. The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences.

  12. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

    National Research Council Canada - National Science Library

    Max P L van der Sijp; Inger B Schipper; Stefan B Keizer; Pieta Krijnen; Arthur HP Niggebrugge

    2017-01-01

    .... The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture...

  13. A Review of Direct Neck Measurement in Occupational Settings

    Directory of Open Access Journals (Sweden)

    Helenice J. C. Gil Coury

    2010-12-01

    Full Text Available No guidelines are available to orient researchers on the availability and applications of equipment and sensors for recording precise neck movements in occupational settings. In this study reports on direct measurements of neck movements in the workplace were reviewed. Using relevant keywords two independent reviewers searched for eligible studies in the following databases: Cinahal, Cochrane, Embase, Lilacs, PubMed, MEDLINE, PEDro, Scopus and Web of Science. After applying the inclusion criteria, 13 articles on direct neck measurements in occupational settings were retrieved from among 33,666 initial titles. These studies were then methodologically evaluated according to their design characteristics, exposure and outcome assessment, and statistical analysis. The results showed that in most of the studies the three axes of neck movement (flexion-extension, lateral flexion and rotation were not simultaneously recorded. Deficiencies in available equipment explain this flaw, demonstrating that sensors and systems need to be improved so that a true understanding of real occupational exposure can be achieved. Further studies are also needed to assess neck movement in those who perform heavy-duty work, such as nurses and electricians, since no report about such jobs was identified.

  14. Evaluating dissection in the gross anatomy course: Correlation between quality of laboratory dissection and students outcomes.

    Science.gov (United States)

    Nwachukwu, Chika; Lachman, Nirusha; Pawlina, Wojciech

    2015-01-01

    Anatomy learned by active exploration through dissection has many proven benefits including improvement of anatomic knowledge. Decreased laboratory time may affect the quality of dissection and ultimately lower student performance in anatomy translating to lower knowledge acquisition. The aim of this study was to determine whether the quality of students' dissection in teams correlates with their performance in the gross anatomy course. Quality of dissections for each team enrolled in a gross anatomy course at Mayo Medical School was evaluated biweekly using a five-point rubric based on course learning objectives. Assessment of anatomic knowledge was based on sequential laboratory practice practical examination scores, achievements on daily audience response system (ARS) quizzes, and final practical, written, and National Board of Medical Examiners(®) (NBME(®) ) Gross Anatomy and Embryology Subject Examinations. Twelve teams comprising 48 students were included in the study. There was a positive correlation between dissection quality and practice practical examination score (R = 0.83) and a negative correlation between dissection quality and ARS quizzes (R = -0.985). Dissection teams with a passing score on their dissection evaluations (>70%) performed better on their final examinations. Based on an end of course survey, students agreed that dissection evaluations should continue to be a part of the course. This study showed that better quality of dissection was associated with higher scores on practice practical examinations, final practical, written, and NBME examinations. The study demonstrated a positive correlation between dissection evaluations, accompanied by formative feedback during the course, and higher scores on final course assessments.

  15. A case of carotid dissection having significant benefit from thrombolytic treatment

    Directory of Open Access Journals (Sweden)

    Sibel Güler

    2016-01-01

    Full Text Available Ischemic stroke due to carotid artery dissection is more common among young people and it accounts about 2-5% of all strokes. A 56 year old left landed male patient was evaluated for left-sided hemiparesis and aphasia in the emergency department. His cranial CT was assessed normal and NIH score was assessed 24 then he undergone thrombolytic therapy. His NIH score was decreased to 14 after 24 hours. At extracranial dupplex USG, cranial MRI and MR-Angiography, done the same day there were findings for carotid dissection. At MR-anjio repeated 5 days later, partial recanalization were seen. At control cranial CT only striocapsüler infarct was seen. There was no any evidence of bleeding as complication. Here we present a rare case of extracranial carotid artery dissection case undergone IV thrombolytic therapy and want to take attention that in carotid dissection IV thrombolytic therapy is quiet safe and there is no difference of complication such as hemorrhage and the prognosis is no different then those with no carotid dissection.

  16. Recovery surgery for extracapsular extension of squamous cell cancer metastasizing to the lymph nodes in the neck

    Directory of Open Access Journals (Sweden)

    D. V. Sikorskiy

    2016-01-01

    Full Text Available Metastatic neck lymph nodes in massive lesion of their tissue with tumor cells are accompanied by extracapsular extension to the adjacent structures in a number of cases. The greatest problem in clinical oncology is when even extended radical neck dissection fails to completely remove tumor tissue that is macroscopically detectable after surgical resection. In this situation, there is a continued growth of tissue mass that is left on the neck. Thus, the unresectable extracapsular spread of neck lymph node metastases to the adjacent tissues reduces the duration of life in the patients and worsens its quality.The basis for this investigation is clinical observations of patients who have been operated on at the Nizhny Novgorod Regional Clinical Oncology Dispensary (Hospital Two in the period 2005 to 2016. Histologically, the tumors were squamous cell carcinomas. In this period, there have been 24 Crile operations (radical neck dissection that are cytoreductive. A primary tumor has been (n = 15 or has not been (n = 9 previously excised. The extracapsular spread of metastatic lymph nodes corresponded to levels IIa, IIb, and III. Cytoreductive cervical lymphadenectomy with the pectoralis musculocutaneous flap covering an unresectable tumor for extracapsular unresectable squamous cell carcinoma metastasizing to the neck lymph nodes should be considered the operation of recovery. This type of surgery is warranted, as tumor mass reduction by eliminating the source of intoxication allows further antitumor treatment (radiotherapy or chemotherapy or their combination that is contraindicated in patients with tumor lysis in the neck. When the cause of death is the exceedingly continued growth of an unresectable component of radio- and chemoresistant variants of tumor tissue on the neck, the covering of the component with a pectoralis major flap delays a fatal outcome in incurable patients to improve a number of quality-of-life indicators.

  17. Individual differences in the preferred neck-resting position of Caribbean flamingos (Phoenicopterus ruber).

    Science.gov (United States)

    Anderson, Matthew J; Williams, Sarah A; O'Brien, Edward H

    2009-01-01

    When resting, flamingos often lay their heads along their backs. While in this position they must curve their necks to either the right or left of their midline. Observations of captive Caribbean flamingos at the Philadelphia Zoo (Philadelphia, PA, USA) were conducted in order to determine if individual birds would display consistent preferences in neck-resting position over multiple observations. While individual birds were shown to vary greatly in regards to the strength and direction of their preferences, a significant flock-level preference towards neck resting to the right was obtained. Analysis of individual flamingos revealed that 5 out of 17 birds displayed preferences that significantly differed from chance, with each of these birds preferring to rest their necks to the right. From the present data we can conclude that flamingos display behavioural laterality of neck-resting position at both the level of the group and that of the individual.

  18. Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study.

    Science.gov (United States)

    Fernández-de-las-Peñas, C; Alonso-Blanco, C; Cuadrado, M L; Pareja, J A

    2006-03-01

    Forward head posture (FHP) and neck mobility were objectively assessed in 25 patients with chronic tension-type headache (CTTH) and 25 healthy controls. Side-view pictures were taken in a sitting position to measure the cranio-vertebral angle. A cervical goniometer was employed to measure the range of all cervical motions. Patients with CTTH showed a smaller cranio-vertebral angle (45.3 degrees +/- 7.6 degrees) than controls (54.1 degrees +/- 6.3 degrees), thus presenting a greater FHP (P neck mobility for all cervical movements, except for right lateral flexion (P angle and neck mobility. Within the CTTH group, a negative correlation was found between the cranio-vertebral angle and headache frequency, but neck mobility did not correlate with headache parameters. Further research is needed to define a potential role of FHP and restricted neck mobility in the origin or maintenance of TTH.

  19. Science Teachers and the Dissection Debate: Perspectives on Animal Dissection and Alternatives

    Science.gov (United States)

    Oakley, Jan

    2012-01-01

    This study investigated Ontario science and biology teachers' practices and attitudes toward animal dissection and dissection alternatives. The data was collected through a mixed methods approach involving online surveys (n = 153) and subsequent telephone interviews (n = 9) with secondary school science and biology teachers. The findings indicate…

  20. A pain in the neck-Imaging in neck sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Lyle, N.J., E-mail: nickylyle@doctors.org.uk [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom); Rutherford, E.E.; Batty, V.B. [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom)

    2011-09-15

    Deep neck infection has a high morbidity and mortality and the extent of infection is often difficult to estimate clinically. The complex anatomy and the communication between neck spaces means that infection can spread along fascial planes leading to life-threatening complications such as airway compromise, vascular erosion/thrombosis, neural dysfunction, and ultimately descending necrotizing mediastinitis. Imaging has an important role to play in identifying the extent of infection and the presence of complications.

  1. Myofascial pain syndrome after head and neck cancer treatment: Prevalence, risk factors, and influence on quality of life.

    Science.gov (United States)

    Cardoso, Leticia Rodrigues; Rizzo, Cláudia Carvalho; de Oliveira, Cleyton Zanardo; dos Santos, Carlos Roberto; Carvalho, André Lopes

    2015-12-01

    Patients undergoing treatment for head and neck cancer may develop myofascial pain syndrome as sequelae. The purpose of this study was to determine the prevalence, risk factors, and quality of life (QOL) related to myofascial pain syndrome. This was a prospective study including patients with head and neck cancer with at least a 1-year disease-free interval. One hundred sixty-seven patients were analyzed, and myofascial pain syndrome was diagnosed in 20 (11.9%). In the multivariate analysis, hypopharyngeal tumors (odds ratio [OR] = 6.35; 95% confidence interval [CI] = 1.58-25.56) and neck dissection (OR = 3.43; 95% CI = 1.16-10.17) were independent factors for myofascial pain syndrome. The pain (p myofascial pain syndrome. Myofascial pain syndrome was observed in 1 of 9 patients after head and neck cancer treatment and a worse QOL was observed among them. Tumor site and neck dissection were found to be risk factors for myofascial pain syndrome. © 2014 Wiley Periodicals, Inc.

  2. Esthesioneuroblastoma: Is There a Need for Elective Neck Treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Demiroz, Candan [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Gutfeld, Orit, E-mail: ogutfeld@gmail.com [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Aboziada, Mohamed; Brown, Doris [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Marentette, Lawrence J. [Department of Otolaryngology, University of Michigan, Ann Arbor, MI (United States); Eisbruch, Avraham [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

    2011-11-15

    Purpose: To assess the risk of cervical lymph node metastases after definitive treatment for esthesioneuroblastoma (ENB) that did not include elective neck therapy. Methods and Materials: This was a retrospective analysis of 26 ENB patients treated at University of Michigan between 1995 and 2007. Tumor stage was Kadish A in 1 patient, B in 19, C in 5, and unknown in 1. Craniofacial or subcranial resection was performed in 24 patients (92%), with negative margins in 22 (92%). Postoperative radiotherapy (RT) to the primary site was given in 12 patients (46%), and 14 patients (54%) had surgery alone. All patients had clinically N0 disease, and no patient underwent elective neck dissection or radiation. Median follow-up was 72 months. Results: Local relapse-free survival was significantly better for patients who received postoperative RT compared with those who had surgery alone: 100% vs. 29% at 5 years, respectively (p = 0.005). Five-year disease-free survival was 87.5% in the RT group vs. 31% in the surgery-alone group (p = 0.05). Regional failure was observed in 7 patients (27%), 6 with Kadish Stage B and 1 with Stage C disease. The most common site of nodal failure was Level II, and 3 patients failed in the contralateral neck. Only 3 patients with regional failure were successfully salvaged. Conclusion: The high rate of regional failures when the neck is not electively treated justifies elective nodal RT in patients with both Kadish Stages B and C. In addition, our experience confirms the beneficial effect on local control of adjuvant RT to the tumor bed.

  3. Finite Element Analysis of the Effects of Head-Supported Mass on Neck Responses

    Science.gov (United States)

    2006-09-01

    head supported mass (HSM) increases the mass of the helmets worn by soldiers. Complaints of neck pain during and after flight have increased amongst...impact (AFRL Biodynamics Data Bank 199405-VDT3292) and lateral impact (Ewing et al. 1976). After tuning the activation of the neck musculature the KTH...the Cervical Intervertebral Disc During Simulated Whiplash , Spine, Vol. 29, Nr. 11, pp 1217-1225, 2004. Shanahan DF and Shanahan MO. Injury in US

  4. Identification and Management of Iatrogenic Aortocoronary Dissection

    Directory of Open Access Journals (Sweden)

    Shao-Ping Nie, MD, PhD, FESC, FSCAI

    2016-05-01

    Full Text Available Iatrogenic aortocoronary dissection (IACD is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap” or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.

  5. The development of a retroperitoneal dissection model.

    Science.gov (United States)

    Yousuf, Aisha A; Frecker, Helena; Satkunaratnam, Abheha; Shore, Eliane M

    2017-10-01

    Knowledge of ureteric anatomy is essential for ureteric injury prevention in laparoscopic gynecologic surgery. Rates of injury increase with limited surgical experience and reduced surgical volume. Currently, there are no low-fidelity or high-fidelity simulation models for teaching and practicing ureteric dissection. Our goal was to design a laparoscopic simulation model for retroperitoneal anatomy with high face validity that is low-cost and easily reproducible. A low-fidelity 3-dimensional simulation model was developed that represents key anatomic structures encountered during retroperitoneal dissection and ureteric identification. Materials, construction steps, and costs were determined. The models were trialed by expert laparoscopic surgeons. Demographic information that included age, gender, surgical experience, and complex laparoscopic case volumes was collected. Face validity was assessed with a 5-item Likert-scale. The total cost of 1 model ranged from $65 to $75. The majority of the materials that were used were reusable, except for 2 components that cost dissection (n=7; 100%), for assessing a learner's ability before performing in the operating room (n=6; 86%), was low-cost (n=7; 100%), and was easily reproducible (n=6; 86%). This unique model fills a gap in laparoscopic simulation training. No other low- or high-fidelity models for laparoscopic retroperitoneal ureteric dissection have been identified in the literature. This simulation model is low-cost, easily reproducible, closely resembles retroperitoneal dissection during laparoscopic gynecologic surgery, and can be used for education and assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Head, Neck, and Oral Cancer

    Science.gov (United States)

    ... a bright light and a mirror: Remove any dentures Look and feel inside the lips and the ... Early treatment may well be the key to complete recovery. Head, Neck & Oral Cancer Facts The information ...

  7. Spontaneous emphysema of the neck.

    Science.gov (United States)

    El-Ghazali, A M

    1983-04-01

    A case of spontaneous emphysema in the neck in a 17-year-old male was reported. Pathogenesis and management are discussed. Although it is a benign and self-limiting condition, it may carry a potential for serious complications.

  8. Neck Rhabdoid Tumors: Clinical Features and Consideration of Autologous Stem Cell Transplant.

    Science.gov (United States)

    Wolfe, Adam D; Capitini, Christian M; Salamat, Shahriar M; DeSantes, Kenneth; Bradley, Kristin A; Kennedy, Tabassum; Dehner, Louis P; Patel, Neha J

    2017-04-03

    Extrarenal malignant rhabdoid tumors (MRT) have a poor prognosis despite aggressive therapy. Adding high-dose chemotherapy with autologous stem cell rescue (HDC-ASCR) as consolidative therapy for MRT is controversial. We describe 2 patients, age 13 years and 19 months, with unresectable neck MRT. After chemotherapy and radiotherapy, both underwent HDC-ASCR and remain in remission over 4 years later. We reviewed all published cases of neck MRT, and found poorer outcomes and more variable age of presentation and time to progression than MRT at other sites. Neck MRT may represent a higher-risk subset of MRT, and addition of HDC-ASCR merits consideration.

  9. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    OpenAIRE

    2016-01-01

    Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20)...

  10. Vertebral Arter Dissection%椎动脉夹层分离

    Institute of Scientific and Technical Information of China (English)

    李志立; 杨树东; 哈志远

    2008-01-01

    The vertebral artery dissection may be associated with the structural abnormalities of vascular wall or enviromental factors.The symptoms are usually caused by the luminal stenosis or the formation of blood clot,including the pain in posterior neck or mastoid region with local neurological deficits.The diagnostic methods for vertebral artery dissection include digital subtraction angiogaphy,magnetic resonance imaging,CT angiograpby and color Doppler ultrasonography.Anticoagulation is the main treatment option for most patients with vertebral artery dissection.%椎动脉夹层分离可能与血管壁结构异常或环境因素有关.症状通常由夹层分离造成管腔狭窄或血凝块形成所致,包括颈后或乳突区疼痛伴随局部神经功能障碍.椎动脉夹层分离的诊断方法包括数字减影血管造影、MRI、CT血管造影以及彩色多普勒超声等.治疗以抗凝为主.

  11. Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study.

    Science.gov (United States)

    Pais, Diogo; Casal, Diogo; Mascarenhas-Lemos, Luís; Barata, Pedro; Moxham, Bernard J; Goyri-O'Neill, João

    2017-03-01

    Teaching time dedicated to anatomy education has been reduced at many medical schools around the world, including Nova Medical School in Lisbon, Portugal. In order to minimize the effects of this reduction, the authors introduced two optional, semester-long cadaveric dissection courses for the first two years of the medical school curriculum. These courses were named Regional Anatomy I (RAI) and Regional Anatomy II (RAII). In RAI, students focus on dissecting the thorax, abdomen, pelvis, and perineum. In RAII, the focus shifts to the head, neck, back, and upper and lower limbs. This study prospectively analyzes students' academic achievement and perceptions within the context of these two, newly-introduced, cadaveric dissection courses. Students' satisfaction was assessed anonymously through a questionnaire that included items regarding students' perception of the usefulness of the courses for undergraduate teaching, as well as with regards to future professional activity. For each of the three academic years studied, the final score (1 to 20) in General Anatomy (GA), RAI, and RAII was on average 14.26 ± 1.89; 16.94 ± 1.02; 17.49 ± 1.01, respectively. The mean results were lower in GA than RAI or RAII (P Educ 10: 127-136. © 2016 American Association of Anatomists.

  12. Neck pain in different cephalalgias

    Directory of Open Access Journals (Sweden)

    E. A. Chechet

    2014-01-01

    Full Text Available The paper reviews the literature related to the investigations of neck pain (cervicalgia in patients with headache (cephalalgia. Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cervicalgia, the prevalence of headache is 20–40% higher than in those with musculoskeletal pain at another site. Neck pain is as a major risk factor for migraine and tension headache (TH. Neck pain in TH progresses with the increased intensity, frequency, and strength of headache. There is a direct relationship of the quality of life worsening associated withcervicalgia to the frequency of migraine attacks and the risk of its chronization. Neck pain is noted in cervicogenic headache belonging to secondary headaches. The identification of mixed headache in a patient with cervicalgia allows the prescription of a treatment option that may be effective in relieving both headache and neck pain. The paper discusses the causes and pathogenesis of cervicalgia in patients with headache, examination methods, and main approaches to drug and nondrug therapies in relation to the leading pathophysiological mechanism, as well as new possibilities for the effective and safe relief of pain syndrome in this category of patients. Nonsteroidal anti-inflammatory drugs, myorelaxants,and their combination are observed to be effective in treating patients with cervicalgia and cephalalgia.

  13. Giant Arteriovenous Malformation of the Neck

    Directory of Open Access Journals (Sweden)

    P. A. Dieng

    2015-01-01

    Full Text Available Arteriovenous malformations (AVM have a wide range of clinical presentations. Operative bleeding is one of the most hazardous complications in the surgical management of high-flow vascular malformations. In the cervical region, the presence of vital vascular structures, such as the carotid artery and jugular vein, may increase this risk. This is a case of massive arteriovenous malformation deforming the neck and the face aspect of this aged lady and growing for several years. A giant mass of the left neck occupied the carotid region and the subclavian region. The AVM was developed between the carotid arteries, jugular veins, and vertebral and subclavian vessels, with arterial and venous flux. The patient underwent surgery twice for the cure of that AVM. The first step was the ligation of the external carotid. Seven days later, the excision of the mass was done. In postoperative period the patient presented a peripheral facial paralysis which completely decreased within 10 days. The first ligation of the external carotid reduces significantly the blood flow into the AVM. It permitted secondarily the complete ablation of the AVM without major bleeding even though multiple ligations were done.

  14. Severe splenic rupture after colorectal endoscopic submucosal dissection

    Science.gov (United States)

    Herreros de Tejada, Alberto; Giménez-Alvira, Luis; Van den Brule, Enrique; Sánchez-Yuste, Rosario; Matallanos, Pilar; Blázquez, Esther; Calleja, Jose L; Abreu, Luis E

    2014-01-01

    Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication. PMID:25071360

  15. [Medical management of cervical arterial dissections].

    Science.gov (United States)

    Vuillier, F; Tatu, L; Moulin, T

    2002-12-01

    Medical management of cervical arterial dissections is not standardized and has not been the subject of randomized trials. Management is mainly based on the presumed pathophysiology of secondary cerebral infarcts associated with dissections and the individual experience of each treating team. First, a review of the literature regarding medical management of acute and chronic dissections is presented. Then, results from a national study sponsored by the Société Française Neuro-Vasculaire and the Société Française de Neuro-Radiologie evaluating the medical management of this pathology in French neuro-vascular centers will be presented. These data will be useful to generate practical management recommendations and establish guidelines for further studies.

  16. The nature of dissection: Exploring student conceptions

    Science.gov (United States)

    York, Katharine

    The model of conceptual change in science describes the process of learning as a complete restructuring of knowledge, when learners discover or are shown more plausible, intelligent alternatives to existing conceptions. Emotions have been acknowledged as part of a learner's conceptual ecology, but the effects of emotions on learning have yet to be described. This research was conducted to examine the role that emotions have on learning for thirteen high school students, as they dissected cats in a Human Anatomy and Physiology class. The project also investigated whether a student's emotional reactions may be used to develop a sense of connectedness with the nonhuman world, which is defined as ecological literacy. This study utilized a grounded theory approach, in which student responses to interviews were the primary source of data. Interviews were transcribed, and responses were coded according to a constant comparative method of analysis. Responses were compared with the four conditions necessary for conceptual change to occur, and also to five principles of ecological literacy. Students who had negative reactions to dissection participated less in the activity, and demonstrated less conceptual change. Two female students showed the strongest emotional reactions to dissection, and also the lowest amount of conceptual change. One male student also had strong negative reactions to death, and showed no conceptual change. The dissection experiences of the students in this study did not generally reflect ecological principles. The two students whose emotional reactions to dissection were the most negative demonstrated the highest degree of ecological literacy. These results provide empirical evidence of the effects that emotions have on learning, and also supports the opinions of educators who do not favor dissection, because it does not teach students to respect all forms of life.

  17. [Surgery of aortic dissection: for which patient?].

    Science.gov (United States)

    Verhoye, Jean-Philippe; Abouliatim, Issam; Larralde, Antoine; Beneux, Xavier; Heautot, Jean-François

    2011-01-01

    In the acute stage (less than two weeks), surgery is indicated for Stanford type A aortic dissections. With respect to the initial work-up, surgery consists in replacing the ascending aorta, sometimes the aortic arch (with supra aortic vessels reimplantation), and aortic valve replacement (valve replacement, Bentall valved tube or valve sparing Tyron David technique). Ischemic visceral complications must be searched for and treated by endovascular techniques or surgery. Aneurismal evolution of chronic dissections must be treated surgically. Replacement can encompass the entire aorta. Copyright © 2010. Published by Elsevier Masson SAS.

  18. Ateriovenous subclavia-shunt for head and neck reconstruction

    Directory of Open Access Journals (Sweden)

    Kübler Norbert R

    2008-11-01

    Full Text Available Abstract Reconstruction of the facial hard- and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection and/or radiotherapy may impede common reconstruction methodes. Even free flaps may not be used without interposition of a vein graft as recipient vessels are not available as a consequence of radical neck dissection. We describe the reconstruction of the facial hard- and soft tissues with a free parasacpular flap in a patient who had received ablative tumor surgery and radical cervical lymphadenectomy as a treatment regimen for squamous cell carcinoma (SCC. To replace the missing cervical blood vessels an arteriovenous subclavia-shunt using a saphena magna graft was created. Microvascular free flap transfer was performed as a 2-stage procedure two weeks after the shunt operation. The microvascular reconstructive technique is described in detail.

  19. Poland's syndrome and head-and-neck tumour: an unusual association causing a reconstruction dilemma.

    Science.gov (United States)

    Gerlinger, Imre; Járai, Tamás; Lujber, László; Pytel, József

    2007-05-01

    Poland's syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. The literature data suggest its sporadic nature. The prevailing theory concerning its cause is hypoplasia of the subclavian artery or its branches, which may lead to a range of developmental changes. Relationships have been demonstrated between tumours and Poland's syndrome and also between tumours and other developmental defects. The explanation may lie in abnormal homeobox and tumour suppressor genes. This paper presents the first literature report of a malignant tonsillo-lingual tumour with metastatic neck involvement in a patient with partial Poland's sequence. In consequence of the aplasia of the pectoralis major muscle, an alternative (a free radical forearm flap) to the routine head-and-neck reconstruction (pedicled pectoralis major flap) was necessitated following tumour excision and radical neck dissection. This case report surveys the diagnostic and therapeutic considerations when previously unnoticed Poland's syndrome is diagnosed in a patient with head-and-neck cancer. One year following major head-and-neck surgery, our patient is tumour-free.

  20. Elective neck management for squamous cell carcinoma metastatic to the parotid area lymph nodes.

    Science.gov (United States)

    Herman, Michael P; Amdur, Robert J; Werning, John W; Dziegielewski, Peter; Morris, Christopher G; Mendenhall, William M

    2016-11-01

    The objective of this study is to determine if radiotherapy (RT) alone to the cervical lymphatics is a suitable alternative to elective neck dissection (END) in patients who undergo parotidectomy and postoperative RT for squamous cell carcinoma metastatic to the parotid area lymph nodes (PALN). We retrospectively reviewed the medical records of 107 patients consecutively treated from November 1969 to March 2012 for cutaneous squamous cell carcinoma metastatic to the PALN with a clinically node-negative neck. Primary therapy consisted of parotidectomy in all cases. We compared regional (cervical) control in two subgroups: 42 patients treated with END and RT and 65 patients treated with elective neck irradiation (ENI) alone. The median time of follow-up was 5.5 years (range 0.3-30 years) for all patients and 11 years for living patients (range 1.8-26 years). There was 1 neck recurrence in each subgroup: END and RT, 1/42 (2 %); and ENI alone, 1/65 (1.5 %). No patient experienced a complication related to neck RT. ENI to a dose of approximately 50-60 Gy is a suitable alternative to END and postoperative RT in patients with squamous cell carcinoma metastatic to the PALN.

  1. Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures

    OpenAIRE

    Han Suk Lee; Hyung Kuk Chung; Sun Wook Park

    2015-01-01

    Objective. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP). Methods. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation...

  2. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

    Directory of Open Access Journals (Sweden)

    Bousoula Eleni

    2011-08-01

    Full Text Available Abstract Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE are described.

  3. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

    Energy Technology Data Exchange (ETDEWEB)

    Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

    2013-08-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

  4. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach.

    Science.gov (United States)

    Loret, Jean-Edouard; Francois, Patrick; Papagiannaki, Chrysanthi; Cottier, Jean-Philippe; Terrier, Louis-Marie; Zemmoura, Ilyess

    2013-07-01

    We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension.

  5. Spontaneous healing of spontaneous coronary artery dissection.

    Science.gov (United States)

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  6. Triangular dissections, aperiodic tilings and Jones algebras

    CERN Document Server

    Coquereaux, Robert

    1994-01-01

    The Brattelli diagram associated with a given bicolored Dynkin-Coxeter graph of type A_n determines planar fractal sets obtained by infinite dissections of a given triangle. All triangles appearing in the dissection process have angles that are multiples of \\pi/ (n+1). There are usually several possible infinite dissections compatible with a given n but a given one makes use of n/2 triangle types if n is even. Jones algebra with index [ 4 \\ \\cos^2{\\pi \\over n+1}]^{-1} (values of the discrete range) act naturally on vector spaces associated with those fractal sets. Triangles of a given type are always congruent at each step of the dissection process. In the particular case n=4, there are isometric and the whole structure lead, after proper inflation, to aperiodic Penrose tilings. The other "tilings" associated with other values of the index are discussed and shown to be encoded by equivalence classes of infinite sequences (with appropriate constraints) using only n/2 digits (if n is even) and generalizing the ...

  7. Nested Dissection Interface Reconstruction in Pececillo

    Energy Technology Data Exchange (ETDEWEB)

    Jibben, Zechariah Joel [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-08-31

    A nested dissection method for interface reconstruction in a volume tracking framework has been implemented in Pececillo. This method provides a significant improvement over the traditional onion-skin method, which does not appropriately handle T-shaped multimaterial intersections and dynamic contact lines present in additive manufacturing simulations. The resulting implementation lays the groundwork for further re- search in numerical contact angle estimates.

  8. Spontaneous resolution late after aortic dissection

    NARCIS (Netherlands)

    Zeebregts, CJAM; Schepens, MAAM; Vermeulen, FEE

    A 50-year-old man was operated on for acute type I (DeBakey classification) aortic dissection. The supracoronary ascending aorta was replaced with an interposition graft. Postoperative computed tomography and angiography clearly revealed a double-barrelled aortic arch, left common carotid artery and

  9. Outcome After Surgery for Acute Aortic Dissection

    DEFF Research Database (Denmark)

    Chemtob, Raphaelle Avigael; Møller-Sørensen, Hasse; Holmvang, Lene

    2017-01-01

    Objectives Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate...

  10. Dissection in Pre-college Education

    OpenAIRE

    Buyukmihci, NC

    2016-01-01

    This paper discusses the educational and ethical issues surrounding dissection of non-human animals in pre-college education. It argues that this exercise has no benefits to students that could possibly be outweighed by the death of healthy animals killed for this purpose.

  11. Conservative management of chronic aortic dissection with underlying aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Mohammad Yusuf Beebeejaun

    2013-01-01

    Full Text Available Aortic dissection is one of the most common aortic emergencies affecting around 2000 Americans each year. It usually presents in the acute state but in a small percentage of patients aortic dissections go unnoticed and these patients survive without any adequate therapy. With recent advances in medical care and diagnostic technologies, aortic dissection can be successfully managed through surgical or medical options, consequently increasing the related survival rate. However, little is known about the optimal long-term management of patients suffering from chronic aortic dissection. The purpose of the present report is to review aortic dissection, namely its pathology and the current diagnostic tools available, and to discuss the management options for chronic aortic dissection, infiltrates or pleural effusions. Other tion. We report a patient in which chronic aortic dissection presented with recurring episodes of vomiting and also discuss the management plan of our patient who had a chronic aortic dissection as well as an underlying aortic aneurysm.

  12. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    Science.gov (United States)

    ... Conditions familial TAAD familial thoracic aortic aneurysm and dissection Printable PDF Open All Close All Enable Javascript ... collapse boxes. Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the aorta , which ...

  13. Coronary Artery Dissection: Not Just a Heart Attack

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Coronary Artery Dissection: Not Just a Heart Attack Updated:Oct 4, ... cannot reach the heart muscle. Spontaneous coronary artery dissection (SCAD) is an uncommon occurrence, but because it ...

  14. Extracapsular dissection of pleomorphic adenoma in the parotid gland: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Shreyas Gupte

    2014-01-01

    Full Text Available Salivary gland tumors comprise of less than 3% of all tumors of the head and neck region. Pleomorphic adenoma represents 45 to 74% of all these salivary gland tumors and 65% of them occur in the parotid gland. Owing to the close proximity of this tumor to the facial nerve, there have been various techniques for surgical management of this tumor in the literature. Extracapsular dissection of pleomorphic adenoma is a conservative treatment modality which spares the handling of facial nerve. We are reporting a case of extracapsular dissection of pleomorphic adenoma in the lower pole of the superfi cial lobe of the parotid gland in a 22 year-old Indian male with a 1-year follow-up.

  15. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    Science.gov (United States)

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

  16. Renal infarction resulting from traumatic renal artery dissection.

    Science.gov (United States)

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang

    2008-06-01

    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  17. THE RELATIONSHIP BETWEEN TMJ DISORDER AND HEAD AND NECK POSTURE

    Directory of Open Access Journals (Sweden)

    Sesi R. Puspita Dewi

    2015-06-01

    Full Text Available Temporomandibular joint disorders may be caused by variety of factors; one of which is the posture of head and neck. However, this remains controversial and a subject of debate by experts. The objective of this study was to know whether there was a relation between temporomandibular disorders and the head and neck posture seen radiographically. Subjects were 40 dental students from University of Indonesia who met the inclusion criteria, selected through questionnaire, and subjective examination based on Helkimo’s dysfunction index. Then, lateral cephalometric radiographs were done to all subjects. In the radiogram, a horizontal line was made from the nasion point to the sella tursica, and a vertical line was drawn along the prominent bone of C1 – C5. The angle between the two lines was measured, and used to represent the head and neck posture. The design of the study was cross sectional. Based on statistical analysis, there was no significant relationship between the anamnestic dysfunction index as well as the clinical dysfunction index that represented the temporomandibular joint disorders and the posture of the head and neck seen radiographically.

  18. The risk for type B aortic dissection in Marfan syndrome

    NARCIS (Netherlands)

    den Hartog, Alexander W.; Franken, Romy; Zwinderman, Aeilko H.; Timmermans, Janneke; Scholte, Arthur J.; van den Berg, Maarten P.; de Waard, Vivian; Pals, Gerard; Mulder, Barbara J. M.; Groenink, Maarten

    2015-01-01

    BACKGROUND: Aortic dissections involving the descending aorta are a major clinical problem in patients with Marfan syndrome. OBJECTIVES: The purpose of this study was to identify clinical parameters associated with type B aortic dissection and to develop a risk model to predict type B aortic dissect

  19. [Nodes Dissections. What's up and what is at stake?].

    Science.gov (United States)

    Guillemin, François; Marchal, Frédéric

    2014-04-01

    Radical nodes dissection has a diagnostic value and can play a part in the treatment. Its interest could be questionable according to efficacy of the associated treatments either adjuvant or neo-adjuvant. Above all, sentinel node dissection allows to avoid a radical dissection with deleterious effects.

  20. Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain.

    Science.gov (United States)

    Ylinen, Jari; Takala, Esa-Pekka; Kautiainen, Hannu; Nykänen, Matti; Häkkinen, Arja; Pohjolainen, Timo; Karppi, Sirkka-Liisa; Airaksinen, Olavi

    2004-10-01

    Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

  1. Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience.

    Science.gov (United States)

    Mattioli, Francesco; Presutti, Livio; Caversaccio, Marco; Bonali, Marco; Anschuetz, Lukas

    2017-06-01

    Objective We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques). Study Design Experimental construction and validation of a highly specialized dissection station. Setting Laboratory and international dissection course. Methods We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction's footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016. Results We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5. Conclusion The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery.

  2. Effects of Expressive Writing Effects on Disgust and Anxiety in a Subsequent Dissection

    Science.gov (United States)

    Randler, Christoph; Wüst-Ackermann, Peter; im Kampe, Viola Otte; Meyer-Ahrens, Inga H.; Tempel, Benjamin J.; Vollmer, Christian

    2015-10-01

    Emotions influence motivation and achievement, but negative emotions have rarely been assessed in science education. In this study, we assessed the influence of two different expressive writing assignments on disgust and anxiety in university students prior to the dissection of a trout. We randomly assigned students to one of two expressive writing tasks and measured specific state disgust and state anxiety after writing and after the dissection. Specific state disgust was measured a third time after 3 weeks. One writing task was concerned with the dissection, and the other was related to behavioral experiments with mice. We used two general linear models with repeated measures. In the first model, specific state disgust (pre, post, and follow-up) was used as the dependent repeated measure and experimental group as the independent variable. In the second model, state anxiety was used as the dependent repeated measure (pre, post) with experimental group as the independent variable. The repeated testing showed a highly significant effect of experimental group on the repeated measures of disgust. Writing about worries and emotions concerning the dissection leads to higher disgust scores compared to writing about mice. These higher scores persisted even 3 weeks later in the follow-up test. Concerning anxiety, there was a clear influence of the repeated measure of state anxiety, but anxiety was not influenced by the experimental group. We suggest that positive writing should be used in educational contexts to reduce disgust.

  3. Inception of cadaver dissection and its relevance in present day scenario of medical education.

    Science.gov (United States)

    Rath, Gayatri; Garg, Krishna

    2006-06-01

    The concept of dissection for acquiring knowledge about the structure of human body was started in 15th century and barber--surgeons used to demonstrate various structures at the professors command. Andreas Vesalius (1514-1564) was the first medical student to dissect the cadaver and also continued with it even as a professor. Slowly and steadily its importance was realised. Once autopsy was accepted as a ideal parameter to establish the causes of death, the importance of dissection got enhanced. Cadavers were obtained earlier from the grave robbings and mortuaries, which was followed by, an Anatomy Act of 1832, by which unclaimed bodies were provided to the anatomy department. For last two decades, many persons started donating their bodies to the department of anatomy. In India, mostly unclaimed bodies are handed over to anatomy department for teaching and research purpose. Cadavers teach students during 1st professional course, autopsy teaches again in IInd and IIIrd professional courses and even later on throughout the career. Dissection helps in developing a spatial and tactile appreciation for the fabric of the human body that cannot be achieved by prosection or computerised learning aids alone.

  4. Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

    Science.gov (United States)

    Kawano, Tatsuyuki; Sugimoto, Taro; Yamaguchi, Kazuya; Kawamura, Yuudai; Matsui, Toshihiro; Okuda, Masafumi; Ogo, Taichi; Kume, Yuuichiro; Nakajima, Yutaka; Mora, Andres; Okada, Takuya; Hoshino, Akihiro; Tokairin, Yutaka; Nakajima, Yasuaki; Okada, Ryuhei; Kiyokawa, Yusuke; Nomura, Fuminori; Asakage, Takahiro; Shimoda, Ryo; Ito, Takashi

    2017-01-01

    Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction. PMID:28154766

  5. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01)

    DEFF Research Database (Denmark)

    Galimberti, Viviana; Cole, Bernard F; Zurrida, Stefano

    2013-01-01

    For patients with breast cancer and metastases in the sentinel nodes, axillary dissection has been standard treatment. However, for patients with limited sentinel-node involvement, axillary dissection might be overtreatment. We designed IBCSG trial 23-01 to determine whether no axillary dissection...... was non-inferior to axillary dissection in patients with one or more micrometastatic (≤2 mm) sentinel nodes and tumour of maximum 5 cm....

  6. Deep space infections of neck.

    Science.gov (United States)

    Kaluskar, S; Bajaj, P; Bane, P

    2007-03-01

    A retrospective study was performed on fourteen cases of deep cervical space infections in the neck admitted for diagnosis and treatment to the ENT Department, during a period of seven years from 1989-1997. Of the fourteen, four patients had Ludwig's angina and of the fourteen, one had a very serious complication resulting in death. Early diagnosis and adequate treatment were of paramount importance. The role of tracheostomy and management of airway in deep cervical space infections of the neck is discussed to gether with bacteriology, antibiotic treatment and surgical management.

  7. Lateral laryngopharyngeal diverticulum: anatomical and videofluoroscopic study

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Milton Melciades Barbosa [Universidade Federal do Rio de Janeiro ICB/CCS/UFRJ, Laboratorio de Motilidade Digestiva e Imagem, S. F1-008, Departamento de Anatomia, Rio de Janeiro (Brazil); Koch, Hilton Augusto [Universidade Federal do Rio de Janeiro ICB/CCS/UFRJ, Departamento de Radiologia, Rio de Janeiro (Brazil)

    2005-07-01

    The aims were to characterize the anatomical region where the lateral laryngopharyngeal protrusion occurs and to define if this protrusion is a normal or a pathological entity. This protrusion was observed on frontal contrasted radiographs as an addition image on the upper portion of the laryngopharynx. We carried out a plane-by-plane qualitative anatomical study through macroscopic and mesoscopic surgical dissection on 12 pieces and analyzed through a videofluoroscopic method on frontal incidence the pharyngeal phase of the swallowing process of 33 patients who had a lateral laryngopharyngeal protrusion. The anatomical study allowed us to identify the morphological characteristics that configure the high portion of the piriform recess as a weak anatomical point. The videofluoroscopic study allowed us to observe the laryngopharyngeal protrusion and its relation to pharyngeal repletion of the contrast medium. All kinds of the observed protrusions could be classified as ''lateral laryngopharyngeal diverticula.'' The lateral diverticula were more frequent in older people. These lateral protrusions can be found on one or both sides, usually with a small volume, without sex or side prevalence. This formation is probably a sign of a pharyngeal transference difficulty associated with a deficient tissue resistance in the weak anatomical point of the high portion of the piriform recess. (orig.)

  8. AN APPROACH TO THE NECK MASS

    African Journals Online (AJOL)

    Enrique

    The neck mass is often surrounded by mystique — in arriving at a diagnosis as ... and Neck Surgery at. Groote Schuur ... picious features include lymph nodes ..... Blood investigations can often exclude ... after treatment with antibiotics, referral.

  9. Neck Circumference and Cardio- Metabolic Syndrome

    OpenAIRE

    Kumar, Nagendran Vijaya; Ismail, Mohammed H.; P, Mahesha; M, Girish; Tripathy, Monica

    2014-01-01

    Background: Only few studies about neck circumference (NC) as a measure of cardio metabolic syndrome available from India. Study was conducted to establish an association between neck circumference and cardio metabolic syndrome.

  10. Which Comes First: The Use of Computer Simulation of Frog Dissection or Conventional Dissection as Academic Exercise?

    Science.gov (United States)

    Akpan, Joseph; Strayer, Jeremy

    2010-01-01

    Science educators and school administrators are reexamining the educational value of animal dissection in the nation's schools and are focusing on simulation as an instructional alternative. One implication of the debate is that simulations can lead to equivalent learning to hands-on dissection. The second implication is whether dissection is…

  11. Which Comes First: The Use of Computer Simulation of Frog Dissection or Conventional Dissection as Academic Exercise?

    Science.gov (United States)

    Akpan, Joseph; Strayer, Jeremy

    2010-01-01

    Science educators and school administrators are reexamining the educational value of animal dissection in the nation's schools and are focusing on simulation as an instructional alternative. One implication of the debate is that simulations can lead to equivalent learning to hands-on dissection. The second implication is whether dissection is…

  12. Strategies and value of the treatment of lateral lymphnode dissection for low rectal cancer in the era of precision medicine%精准医疗时代低位直肠癌选择性侧方淋巴结清扫价值与策略

    Institute of Scientific and Technical Information of China (English)

    王海江; 葛磊

    2016-01-01

    随着生物分析技术、基因测序以及大数据分析工具的出现,医学进入了精准医疗时代。临床影像等技术的进步和发展,肿瘤患者术前精准临床分期判断及分子生物学信息的获得使得个体化的精准医疗成为可能,精准医疗时代对直肠癌的诊治提出了新的要求,不同部位的直肠癌治疗方案亦有所差异。手术治疗仍然是当今治疗直肠癌的主要方式,对于侧方淋巴结清扫问题一直存有争议,究其原因侧方淋巴结转移(lateral pelvic lymph node metastasis,LPLM)是全身系统性转移还是局部转移。笔者认为,低位直肠癌诊治应在充分推广诊疗规范的基础上,通过对数据的分析,筛选行侧方淋巴结手术治疗的获益人群,根据精确的诊断分期控制手术指征与范围,减少不必要的创伤及过度治疗从而真正实现精准医疗。%With the emergency of biological technology, gene sequencing and big data analysis tools, medical treatment entered the era of precision medical. As a result of the progress and development of clinical imaging techniques, the acquisition of clinical and personal biological data has made personalized treatment possible. The era of precision medicine has brought new horizon for diagnosis and treatment of rectal cancer. Different treatment should be taken into account in a different location in rectal cancer. Surgery is still considered as the principal treatment for rectal cancer, however, there is long-standing controversy as to whether LPN metastases represent systemic or localized disease. Based on the promotion of standard treatment for rectal cancer, we must share following views that the different subjects should join forces to improve selection criteria for LPND, avoid unnecessary injury, prevent over treatment, and ultimately aim to propose the precision medicine program in the future for patients with low rectal cancer.

  13. Head and Neck Soft Tissue Sarcoma

    OpenAIRE

    Aljabab, A. S.; Nason, R. W.; Kazi, R; Pathak, K. A.

    2011-01-01

    Sarcomas are malignant neoplasms originating from mesodermal tissues and constitute less than 1% of body’s tumors, including those of the head and neck region. 5–15% of adult sarcomas are in the head and neck region (20% from bones and cartilages and 80% in soft tissues). Commonly encountered sarcomas in the head and neck region are - osteosarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, fibrosarcoma and angiosarcoma. This article reviews the available literature on head and neck sa...

  14. An integrated approach to understanding the role of the long neck in plesiosaurs

    Directory of Open Access Journals (Sweden)

    Leslie F. Noè

    2017-03-01

    Full Text Available The evolution and function of the long neck in plesiosaurs, and how the problems associated with stiffness or flexibility were overcome during feeding, or rapid swimming during predator avoidance, are explored, and a new interpretation for the function of the plesiosaur neck is presented. Based on the anatomy of the articular faces of contiguous cervical vertebral centra, neural arches, and cervical ribs, the plesiosaur neck was mainly adapted for ventral bending, with dorsal, lateral and rotational movements all relatively restricted. Predominant ventral bending indicates the neck was adapted for use beneath the body, suggesting feeding in the water column, close to the sea floor, or within soft sediments on the sea floor. A new model is proposed for the plesiosaur bauplan, comprising the head as a filter, straining, sieve feeding or sediment raking apparatus, mounted on a neck which acted as a stiff but ventrally flexible feeding tube, attached to the body which acted as a highly mobile feeding platform. Numerous features of plesiosaurs, including cranial and dental form, cervical vertebral morphology, body shape and limb-based propulsion, conform to this model. Comparative data from modern organisms support this novel explanation for the structure and function of the plesiosaur long neck. This integrative analysis offers an explanation for the evolution of the plesiosaur long neck as a key evolutionary novelty, and why this apparently enigmatic feature remained a prominent feature of plesiosaurs throughout their long evolutionary history.

  15. Neck sprain--a major cause of disability following car accidents.

    Science.gov (United States)

    Deans, G T; Magalliard, J N; Kerr, M; Rutherford, W H

    1987-01-01

    One hundred and thirty-seven patients attending hospital following road traffic accidents were contracted regarding pain in the neck between 1 and 2 years later. Eighty-five (62 per cent) stated that they had suffered pain in the neck at some time following their accident compared with 42 (30.6 per cent) who were noted to have pain in the neck when examined soon after the accident. Thirty-one patients (22.6 per cent) still felt occasional pain 1 year after the accident and 5 had continuous pain at 1 year. Pain in the neck occurred irrespective of the direction of impact but was disproportionately common in rear impact accidents. Patients wearing seat belts experienced pain more frequently than unbelted patients.

  16. X-Ray Exam: Neck (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Neck KidsHealth > For Parents > X-Ray Exam: Neck A A A What's in ... español Radiografía: cuello What It Is A neck X-ray is a safe and painless test that ...

  17. A Laboratory Manual for Stepwise Cerebral White Matter Fiber Dissection.

    Science.gov (United States)

    Koutsarnakis, Christos; Liakos, Faidon; Kalyvas, Aristotelis V; Sakas, Damianos E; Stranjalis, George

    2015-08-01

    White matter fiber dissection is an important method in acquiring a thorough neuroanatomic knowledge for surgical practice. Previous studies have definitely improved our understanding of intrinsic brain anatomy and emphasized on the significance of this technique in modern neurosurgery. However, current literature lacks a complete and concentrated laboratory guide about the entire dissection procedure. Hence, our primary objective is to introduce a detailed laboratory manual for cerebral white matter dissection by highlighting consecutive dissection steps, and to stress important technical comments facilitating this complex procedure. Twenty adult, formalin-fixed cerebral hemispheres were included in the study. Ten specimens were dissected in the lateromedial and 10 in the mediolateral direction, respectively, using the fiber dissection technique and the microscope. Eleven and 8 consecutive and distinctive dissection steps are recommended for the lateromedial and mediolateral dissection procedures, respectively. Photographs highlighting various anatomic landmarks accompany every step. Technical recommendations, facilitating the dissection process, are also indicated. The fiber dissection technique, although complex and time consuming, offers a three-dimensional knowledge of intrinsic brain anatomy and architecture, thus improving both the quality of microneurosurgery and the patient's standard of care. The present anatomic study provides a thorough dissection manual to those who study brain anatomy using this technique. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Spontaneous Coronary Artery Dissection: The Phantom Menace

    Science.gov (United States)

    Spinthakis, Nikolaos; Abdulkareem, Nada; Farag, Mohamed; Gorog, Diana A.

    2016-01-01

    We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography. Unlike most other lesions in patients with unstable symptoms, where coronary intervention with stenting is recommended, patients with SCAD generally fare better with conservative measures than with intervention, unless there is hemodynamic instability. PMID:28197295

  19. Endoscopic submucosal dissection for gastrointestinal neoplasms

    Institute of Scientific and Technical Information of China (English)

    Naomi Kakushima; Mitsuhiro Fujishiro

    2008-01-01

    Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion,cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms.Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

  20. Counter traction makes endoscopic submucosal dissection easier.

    Science.gov (United States)

    Oyama, Tsuneo

    2012-11-01

    Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier.

  1. Endoscopic submucosal dissection for stomach neoplasms

    Institute of Scientific and Technical Information of China (English)

    Mitsuhiro Fujishiro

    2006-01-01

    Recent advances in techniques of therapeutic endoscopy for stomach neoplasms are rapidly achieved. One of the major topics in this field is endoscopic submucosal dissection (ESD). ESD is a new endoscopic technique using cutting devices to remove the tumor by thefollowing three steps: injecting fluid into the submucosa to elevate the tumor from the muscle layer, pre-cutting the surrounding mucosa of the tumor, and dissecting the connective tissue of the submucosa beneath the tumor. So the tumors are resectable in an en bloc fashion, regardless of the size, shape, coexisting ulcer,and location. Indication for ESD is strictly confined by two aspects: the possibility of nodal metastases and technical difficulty, which depends on the operators. Although long-term outcome data are still lacking, short-term outcomes of ESD are extremely favourable and laparotomy with gastrectomy is replaced with ESD in some parts of therapeutic strategy for early gastric cancer.

  2. Aortic growth rates in chronic aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, A.M. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States)]. E-mail: ainekell@med.umich.edu; Quint, L.E. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Nan, B. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Zheng, J. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Cronin, P. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Deeb, G.M. [Division of Cardiac Surgery, University of Michigan Medical Center (United States); Williams, D.M. [Division of Vascular Interventional Imaging, University of Michigan Medical Center (United States)

    2007-09-15

    Aim: To determine and compare rates of descending aortic enlargement and complications in chronic aortic dissection with and without a proximal aortic graft. Methods and materials: Fifty-two patients with dissection involving the descending aorta and who had undergone at least two computed tomography (CT) examinations at our institution between November, 1993 and February, 2004 were identified, including 24 non-operated patients (four type A, 20 type B) and 28 operated patients (type A). CT examinations per patient ranged from two to 10, and follow-up ranged from 1-123 months (mean 49 months, median 38.5 months). On each CT image, the aortic short axis (SA), false lumen (FL), and true lumen (TL) diameters were measured at the longitudinal midpoint of the dissection and at the point of maximum aortic diameter. Complications were tabulated, including aortic rupture and aortic enlargement requiring surgery. Results: For non-operated patients, the midpoint and maximum point SA, TL, and FL diameters increased significantly over time. For operated patients, the midpoint and maximum point SA and FL diameters increased significantly over time. In both groups, aortic enlargement was predominantly due to FL expansion. Diameter increases in non-operated patients were significantly larger than those in operated patients. The rate of change in aortic diameter was constant, regardless of aortic size. Four non-operated and six operated patients developed aortic complications. Conclusions: In patients with a dissection involving the descending thoracic aorta, the FL increased in diameter over time, at a constant rate, and to a greater degree in non-operated patients (mostly type B) compared with operated patients (all type A)

  3. Fever of unknown origin in aortic dissection.

    Science.gov (United States)

    Yuan, S-M

    2017-05-01

    Aortic dissection is the most devastating sequela of thoracic aortic disorder. Patients with acute aortic dissection typically manifest as an acute onset of severe chest pain, but occasionally present with atypical symptoms including fever of unknown origin. A total of 50 patients from 41 articles based on a complete literature retrieval were included in this study. More patients had a fever prior to pain. The time to presentation was 40.7 ± 105.6 days, the time to diagnosis was 52.9 ± 110.1 days, and the time to surgery/intervention was 1.8 ± 5.6 days. The patients' temperature on admission was 38.2 ± 0.6 °C and the maximal temperature recorded was 38.8 ± 0.4 °C. Laboratory findings showed increased white blood cell counts, cardiac enzymes, and inflammatory biomarkers. More pronounced laboratory findings of the infectious type than the inflammatory type aortic dissection could be helpful in the differential diagnosis. Half of patients warrant aortic repair with or without valve replacement, less than half of patients were conservatively managed, and a few were interventionally treated or were being followed up. The mortality rate was 9.5 %. Physicians should always bear in mind aortic dissection when patients present with fever of unknown origin particularly in those without chest pain. Laboratory findings may offer inflammatory evidence for the diagnosis. An early diagnosis as well as subsequent treatment is indispensable for patients' outcomes.

  4. Nested Dissection Interface Reconstruction in Pececillo

    Energy Technology Data Exchange (ETDEWEB)

    Jibben, Zechariah Joel [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Computer, Computational, and Statistical Sciences Division; Carlson, Neil N. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Computer, Computational, and Statistical Sciences Division; Francois, Marianne M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Computer, Computational, and Statistical Sciences Division

    2016-09-13

    A nested dissection method for interface reconstruction in a volume tracking framework has been implemented in Pececillo, a mini-app for Truchas, which is the ASC code for casting and additive manufacturing. This method provides a significant improvement over the traditional onion-skin method, which does not appropriately handle T-shaped multimaterial intersections and dynamic contact lines present in additive manufacturing simulations. The resulting implementation lays the groundwork for further research in contact angle estimates and surface tension calculations.

  5. Whole vitreous humor dissection for vitreodynamic analysis.

    Science.gov (United States)

    Murali, Karthik; Kashani, Amir H; Humayun, Mark S

    2015-05-24

    The authors propose an effective technique to isolate whole, intact vitreous core and cortex from post mortem enucleated porcine eyes. While previous studies have shown the results of such dissections, the detailed steps have not been described, precluding researchers outside the field from replicating their methods. Other studies harvest vitreous either through aspiration, which does not maintain the vitreous structure anatomy, or through partial dissection, which only isolates the vitreous core. The proposed method isolates the whole vitreous body, with the vitreous core and cortex intact, while maintaining vitreous anatomy and structural integrity. In this method, a full thickness scleral flap in an enucleated porcine eye is first created and through this, the choroid tissue can be separated from the sclera. The scleral flap is then expanded and the choroid is completely separated from the sclera. Finally the choroid-retina tissue is peeled off the vitreous to leave an isolated intact vitreous body. The proposed vitreous dissection technique can be used to study physical properties of the vitreous humor. In particular, this method has significance for experimental studies involving drug delivery, vitreo-retinal oxygen transport, and intraocular convection.

  6. Tennis Elbow (Lateral Epicondylitis)

    Science.gov (United States)

    .org Tennis Elbow (Lateral Epicondylitis) Page ( 1 ) Tennis elbow, or lateral epicondyliti s, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause ...

  7. Functional anatomy of the human lateral pterygoid muscle.

    Science.gov (United States)

    El Haddioui, A; Laison, F; Zouaoui, A; Bravetti, P; Gaudy, J F

    2005-11-01

    The authors studied the lateral pterygoid muscle of 179 fresh cadavers by both anatomical dissection and magnetic resonance imaging. The aim was to define the general morphology and the architectural organisation of the lateral pterygoid muscle. Dissection plane by plane, anatomical sections in different planes of space and dissections via multiple approaches on harvested blocks allowed the demonstration that the lateral pterygoid shows an architectural arrangement different from that which is usually described but similar to that, from its typically penniform structure of the masseter and the medial pterygoid. The anatomical situation of this muscle gives rise to numerous differences in opinion much to its morphology as to its functional examination. This study has shown that one part of the muscle has a typical penniform structure made up of alternating musculo-aponeurotic layers and by the absence of individual muscle bellies. In addition the particular shape of this muscle makes it useless to insert intramuscular electrodes in its only accessible portion, which makes the results of electromyographic studies debatable.

  8. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America.

    Science.gov (United States)

    Lira, Renan Bezerra; Chulam, Thiago Celestino; Kowalski, Luiz Paulo

    2017-06-01

    In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected

  9. Gradation of Neck Muscle Responses and Head/Neck Kinematics to Acceleration and Speed Change in Rear-end Collisions.

    Science.gov (United States)

    Siegmund, Gunter P; Sanderson, David J; Inglis, J Timothy

    2004-11-01

    Recent epidemiological evidence shows that the potential for whiplash injury varies with both the average acceleration and speed change of a rear-end collision. The goal of this study was to examine the gradation of neck muscle responses and the head and neck kinematics to rear-end collision pulses in which the acceleration and speed change were independently varied. Thirty subjects (15F, 15M) underwent 36 consecutive rear-end collisions consisting of three different average accelerations (ā = 0.5, 0.9 and 1.3 g) and three different speed changes (Deltav = 0.25, 0.50 and 0.75 m/s). Onset and amplitude of the sternocleidomastoid (SCM) and cervical paraspinal (PARA) muscle responses were measured using surface electromyography. Kinematic measures included linear and angular accelerations and displacements of the head and torso. The results showed that the amplitude of the muscle and kinematics responses was graded to both collision acceleration and speed change. The magnitude of early peaks in the head/neck kinematics correlated more strongly with collision acceleration (r(2) = 0.63 to 0.69), whereas the magnitude of later kinematic peaks correlated more strongly with collision speed change (r(2) = 0.59 to 0.95). Onset of the SCM muscle response correlated only weakly with collision acceleration and speed change (r(2) acceleration and speed change (āDeltav) yielded the strongest and most consistent correlations with neck muscle (r(2) = 0.48 to 0.58) and head/neck kinematic responses (r(2) = 0.78 to 0.94). This measure of collision severity is also consistent with the recent epidemiological evidence that whiplash symptom intensity and duration increases with both average acceleration and speed change.

  10. Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?

    Science.gov (United States)

    Tarsitano, A; Pizzigallo, A; Sgarzani, R; Oranges, C M; Cipriani, R; Marchetti, C

    2012-12-01

    The safety and success of microvascular transfer have been well documented in the general population, but the good results achieved with the use of free flaps in elderly patients have received little attention. This study sought to identify differences in complications, morbidity and functional outcomes between elderly (≥ 75 years) and younger (patients treated surgically for advanced head and neck cancer using the Head and Neck 35 module of the European Organisation for Research and Treatment of Cancer quality of life questionnaire. Patient treatment consisted of composite resection, including excision of the primary tumour with ipsilateral or bilateral neck dissection and microvascular reconstruction. Eighty-five microvascular tissue transfers were performed to reconstruct major surgical defects. Postoperative radiation therapy was performed when indicated. Total flap loss occurred in three cases in elderly patients and two cases in younger patients. The rates of major surgical complication were 9% in young patients and 11% in elderly patients. No significant difference was observed between the two groups in the rates of major and minor flap complications, morbidity or long-term functional outcome. The results of the present analysis indicate that free-flap microvascular reconstruction can be considered a safe procedure in elderly patients with head and neck cancer.

  11. Pectoralis major flap for head and neck reconstruction in era of free flaps.

    Science.gov (United States)

    Kekatpure, V D; Trivedi, N P; Manjula, B V; Mathan Mohan, A; Shetkar, G; Kuriakose, M A

    2012-04-01

    The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.

  12. The Role of Computed Tomography in the Management of the Neck After Chemoradiotherapy in Patients With Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Charron, Marie-Pierre [Faculte de medicine, Universite de Montreal, Montreal, Quebec (Canada); Belair, Manon [Department of Radiology, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Delouya, Guila; Fortin, Bernard; Despres, Philippe [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Soulieres, Denis [Department of Medical Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Filion, Edith [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); and others

    2012-02-01

    Purpose: The aim of this study was to describe the outcome in patients with head-and neck-squamous cell carcinoma (HNSCC) followed up without neck dissection (ND) after concomitant chemoradiotherapy (CRT) based on computed tomography (CT) response. The second objective was to establish CT characteristics that can predict which patients can safely avoid ND. Methods and Materials: Between 1998 and 2007, 369 patients with node-positive HNSCC were treated with primary CRT at our institution. After a clinical and a radiologic evaluation based on CT done 6 to 8 weeks after CRT, patients were labeled with a complete neck response (CR) or with a partial neck response (PR). Results: The median follow-up was 44 months. The number of patients presenting with N3, N2, or N1 disease were 54 (15%), 268 (72%), and 47 (13%), respectively. After CRT, 263 (71%) patients reached a CR, and 253 of them did not undergo ND. Ninety-six patients reached a PR and underwent ND. Of those, 34 (35%) had residual disease on pathologic evaluation. A regression of the diameter of {>=}80% and a residual largest diameter of 15 mm of nodes had negative pathologic predictive values of 100% and 86%, respectively. The 3-year regional control and survival rates were not different between patients with CR who had no ND and patients with PR followed by ND. Conclusion: Node-positive patients presenting a CR as determined by CT evaluation 6 to 8 weeks after CRT had a low rate of regional recurrence without ND. This study also suggests that lymph node residual size and percentage of regression on CT after CRT may be useful criteria to guide clinical decisions regarding neck surgery. Those results can help diminish the number of ND procedures with negative results and their associated surgical complications.

  13. Lateral Transpsoas Fusion: Indications and Outcomes

    Directory of Open Access Journals (Sweden)

    Vishal C. Patel

    2012-01-01

    Full Text Available Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

  14. Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair.

    Science.gov (United States)

    Casana, R; Tolva, V; Majnardi, A Robecchi; Bianchi, P G; Addobati, L; Bertoni, G B; Cireni, L V; Silani, V

    2011-10-01

    Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery. Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome. According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.

  15. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD)

    National Research Council Canada - National Science Library

    Pape, Linda A; Tsai, Thomas T; Isselbacher, Eric M; Oh, Jae K; O'gara, Patrick T; Evangelista, Arturo; Fattori, Rossella; Meinhardt, Gabriel; Trimarchi, Santi; Bossone, Eduardo; Suzuki, Toru; Cooper, Jeanna V; Froehlich, James B; Nienaber, Christoph A; Eagle, Kim A

    2007-01-01

    .... However, few studies of acute aortic dissection patients and aortic size exist. We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type A dissection...

  16. Peer-Assisted Learning in a Gross Anatomy Dissection Course.

    Science.gov (United States)

    Han, Eui-Ryoung; Chung, Eun-Kyung; Nam, Kwang-Il

    2015-01-01

    Peer-assisted learning encourages students to participate more actively in the dissection process and promotes thoughtful dissection. We implemented peer-assisted dissection in 2012 and compared its effects on students' self-assessments of learning and their academic achievement with those of faculty-led dissection. All subjects performed dissections after a lecture about upper-limb gross anatomy. Experimental group (n = 134) dissected a cadaver while guided by peer tutors who had prepared for the dissection in advance, and control group (n = 71) dissected a cadaver after the introduction by a faculty via prosection. Self-assessment scores regarding the learning objectives related to upper limbs were significantly higher in experimental group than in control group. Additionally, experimental group received significantly higher academic scores than did control group. The students in peer-assisted learning perceived themselves as having a better understanding of course content and achieved better academic results compared with those who participated in faculty-led dissection. Peer-assisted dissection contributed to self-perception and to the ability to retain and explain anatomical knowledge.

  17. Background music in the dissection laboratory: impact on stress associated with the dissection experience.

    Science.gov (United States)

    Anyanwu, Emeka G

    2015-06-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on stress associated with the dissection experience. After 8 wk of normal dissection without BM, various genres of BM were introduced into the cadaver dissection sessions of 260 medical and dental students for 3 wk. Feedback on the impact of BM on students in the CDL and students' attitude were accessed using a questionnaire. Psychological stress assessment was done using Psychological Stress Measure 9. Two batches of 30 students each were made to dissect same areas of the body for 2 h, one batch with BM playing and the other batch without. The same examination was given to both groups at the end. Over 90% of the participants expressed a desire to incorporate BM into the CDL; 87% of the sampled population that expressed love for music also reported BM to be a very useful tool that could be used to enhance learning conditions in the CDL. A strong positive relationship was established between love for music and its perception as a tool for learning in the CDL (P < 0.001). Students that studied under the influence of BM had significantly higher scores (P < 0.001) in the overall examination result. BM reduced the level of stress associated with the dissection experience by ∼33%. Copyright © 2015 The American Physiological Society.

  18. Aberrant cervical vasculature anastomosis as cause of neck pain and successful treatment with embolization technique.

    Science.gov (United States)

    He, Lucy; Ladner, Travis R; Cobb, Mark; Mocco, J

    2016-01-27

    We report a patient with non-dermatomal radiating neck pain without focal neurologic deficit. Traditional workup could not identify an anatomic or biomechanical cause. Imaging showed a deep cervical vessel centered in the region of pain. Angiography later identified an aberrant anastomosis of this vessel with the occipital artery. Subsequent endovascular embolization of this arterial trunk resulted in complete pain relief.

  19. Translation and validation study of the Iranian versions of the Neck Disability Index and the Neck Pain and Disability Scale.

    Science.gov (United States)

    Mousavi, Sayed Javad; Parnianpour, Mohamad; Montazeri, Ali; Mehdian, Hossein; Karimi, Abdolkarim; Abedi, Mohsen; Ashtiani, Ahmadreza Askary; Mobini, Bahram; Hadian, Mohamad Reza

    2007-12-15

    Cultural translation and psychometric testing. To translate and validate the Iranian versions of the Neck Disability Index (NDI-IR) and the Neck Pain and Disability Scale (NPDS-IR). The widely used the NDI and the NPDS scales have not been translated and validated for Persian-speaking patients with neck pain. This was to provide a validated instrument to measure functional status in patients with neck pain in Iran. The translation and cultural adaptation of the original questionnaires were carried out in accordance with the published guidelines. One hundred and eighty-five patients with neck pain were participated in the study. Patients were asked to complete a questionnaire booklet including the NDI-IR, the NPDS-IR, the Iranian SF-36, and a visual analog scale (VAS) of pain. To carry out the test-retest reliability, 30 randomly selected patients with neck pain were asked to complete the questionnaire booklet 48 hours later for the second time. Cronbach alpha coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory (ranging from 0.74 to 0.94). The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability (intraclass correlation coefficient ranged from 0.90 to 0.97; P < 0.01). The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results, indicating a good convergent validity (Pearson correlation coefficients ranged from -0.31 to -0.70). The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 (P < 0.01). The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran. They are simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian speaking communities.

  20. Neck muscle function in violinists/violists with and without neck pain.

    Science.gov (United States)

    Steinmetz, Anke; Claus, Andrew; Hodges, Paul W; Jull, Gwendolen A

    2016-04-01

    Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG amplitudes during CCFT than the pain-free musicians and non-musicians (P neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.

  1. The Role of 3 Tesla Diffusion-Weighted Imaging in the Differential Diagnosis of Benign versus Malignant Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Flavio Barchetti

    2014-01-01

    Full Text Available Objective. The aim of this study was to validate the role of diffusion-weighted imaging (DWI at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC. Materials and Methods. Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se and specificity (Spe of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. Results. In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC value was 0.903 × 10−3 mm2/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10−3 mm2/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC of 0.964, while morphological criteria displayed an AUC of 0.715. Conclusions. In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.

  2. The Role of 3 Tesla Diffusion-Weighted Imaging in the Differential Diagnosis of Benign versus Malignant Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma

    Science.gov (United States)

    Pranno, Nicola; Sartori, Alessandro; Gigli, Silvia; Lo Mele, Luigi; Marsella, Luigi Tonino

    2014-01-01

    Objective. The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Materials and Methods. Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. Results. In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10−3 mm2/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10−3 mm2/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715. Conclusions. In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection. PMID:25003115

  3. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    Directory of Open Access Journals (Sweden)

    Sabry Omar

    2014-01-01

    Full Text Available We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

  4. Radiotherapy of metastatic neck nodes from an unknown primary site

    Energy Technology Data Exchange (ETDEWEB)

    Park, I. K.; Yun, S. M.; Kim, J. C. [Kyungpook National Univ., Taegu (Korea, Republic of). Coll. of Medicine

    1997-06-01

    This study was to evaluate survival, failure patterns, and prognostic factors of patients with metastatic neck nodes from an unknown primary site. A retrospective analysis was done for 35 patients with metastatic neck nodes from an unknown primary site who were treated with radiation from January 1986 to September 1994. There were 26 male and 9 female patients. Patients` age ranged from 41 to 74 years (median 58 years). Radiation therapy alone was done in 7 patients, induction chemotherapy and radiation therapy in 10, and postoperative radiation therapy in 18. Radiation therapy fields included both neck and pharyngeal axis, and total dose was 40-95.6Gy using 6MV X-ray. Chemotherapy consisted of 2 cycles of 5-fluorouracil and cisplatin. Surgical methods were a radical neck dissection in 17 patients and an excisional biopsy in 1 patient. Follow-up time ranged from 2 to 95 months, median 15 months. Overall and disease-free survival rate at 4 years were 33.4% and 33.9%, respectively. The factors associated with the overall survival rate were histologic type (adenocarcinoma vs. non-adenocarcinoma ), N stage, and the site of involved nodes. According to the treatment modality, 2-year survival rate was 14.3% in radiation therapy alone group, 35.8% in induction chemotherapy and radiation therapy, and 37.5% in postoperative radiation therapy, which might be due to the difference of N stage distribution. Local failure was noted in 7 patients, distant metastases in 6, local failure and distant metastases in 1. Excluding the 7 patients with supraclavicular lymph node metastases alone, 28%(7/25) of the patients had distant metastases. During the follow-up period, 11%(3/35) of the patients showed a delayed primary site, 1 in oral cavity, 1 in nasopharynx and 1 in hypopharynx. N stage, the site of involved node, and histologic type were associated with survival rate. In patients with advanced N stage, curative rather than inductive chemotherapy is needed because combined surgery

  5. Mosaic double aneuploidy (45,X/47,XX,+8) with aortic dissection.

    Science.gov (United States)

    Lee, M N; Choi, K H; Kim, D K; Kim, S H

    2014-01-01

    Chromosomal aneuploidy is considerably frequent and may involve either autosomes or sex chromosomes. While double aneuploidy involving both autosomal and sex chromosomes is rare, several reports described the cases of sex chromosomal aneuploidies in combination with trisomy 21, such as Down-Klinefelter and Down-Turner syndrome. However, trisomy 8-Turner syndrome has been rarely described to date. Here we report a case of a 28-year-old female with mosaic trisomy 8-Turner syndrome. The patient was referred to our hospital for aortic dissection. On physical evaluation, features of her phenotype, which included short stature, webbed neck and cubitus valgus, suggested congenital anomalies such as Turner syndrome. Chest CT revealed aortic dissection with bicuspid aortic valve and coarctation. G-banding cytogenetic analysis of peripheral blood showed mosaicism with two cell lines (45,X[17]/47,XX,+8[33]). FISH analysis indicated that 15% of the cells were of monosomy X karyotype and 85% of the cells were with XX karyotype and trisomy 8 was detected only in XX cells. Though the patient exhibited clinical features of Turner syndrome, somatic stigmas present were not clearly distinguishable from those of trisomy 8, such as short stature, skeletal and cardiac abnormalities. Observations from most of the double aneuploidy cases indicated that the patient's phenotype was not necessarily in correlation to the ratio of autosomal and sex chromosomal aberrations. Mosaicism in trisomy 8-Turner syndrome was rarely documented and we believe this is the first reported case of mosaicism in trisomy 8-Turner syndrome presenting with aortic dissection and surviving into adulthood.

  6. Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Alexander L. Pan

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

  7. Metabolic signature of electrosurgical liver dissection.

    Directory of Open Access Journals (Sweden)

    Witigo von Schönfels

    Full Text Available BACKGROUND AND AIMS: High frequency electrosurgery has a key role in the broadening application of liver surgery. Its molecular signature, i.e. the metabolites evolving from electrocauterization which may inhibit hepatic wound healing, have not been systematically studied. METHODS: Human liver samples were thus obtained during surgery before and after electrosurgical dissection and subjected to a two-stage metabolomic screening experiment (discovery sample: N = 18, replication sample: N = 20 using gas chromatography/mass spectrometry. RESULTS: In a set of 208 chemically defined metabolites, electrosurgical dissection lead to a distinct metabolic signature resulting in a separation in the first two dimensions of a principal components analysis. Six metabolites including glycolic acid, azelaic acid, 2-n-pentylfuran, dihydroactinidiolide, 2-butenal and n-pentanal were consistently increased after electrosurgery meeting the discovery (p<2.0 × 10(-4 and the replication thresholds (p<3.5 × 10(-3. Azelaic acid, a lipid peroxidation product from the fragmentation of abundant sn-2 linoleoyl residues, was most abundant and increased 8.1-fold after electrosurgical liver dissection (preplication = 1.6 × 10(-4. The corresponding phospholipid hexadecyl azelaoyl glycerophosphocholine inhibited wound healing and tissue remodelling in scratch- and proliferation assays of hepatic stellate cells and cholangiocytes, and caused apoptosis dose-dependently in vitro, which may explain in part the tissue damage due to electrosurgery. CONCLUSION: Hepatic electrosurgery generates a metabolic signature with characteristic lipid peroxidation products. Among these, azelaic acid shows a dose-dependent toxicity in liver cells and inhibits wound healing. These observations potentially pave the way for pharmacological intervention prior liver surgery to modify the metabolic response and prevent postoperative complications.

  8. Contemporary Management of Acute Type B Dissection.

    Science.gov (United States)

    Scott, A J; Bicknell, C D

    2016-03-01

    Growing confidence in thoracic endovascular aortic repair (TEVAR) for the management of acute type B aortic dissection has resulted in controversies regarding optimum patient selection and the timing of intervention. In this review a clinical vignette to present a practical perspective on the contemporary management of acute type B dissection (ABAD) in a specialist vascular centre with particular focus on areas of debate is used. This is a narrative clinical review. Aggressive anti-impulse therapy is the cornerstone of management of all patients with ABAD. However, 20-30% of patients develop complicated ABAD defined by the presence of malperfusion syndromes, acute aortic dilatation, dissection extension, or persistent pain and hypotension. These complicated patients typically require intervention, and non-randomised series suggest TEVAR to be an effective alternative to open repair with a lower morbidity. There is considerable interest and controversy surrounding the use of TEVAR in uncomplicated ABAD patients for whom the intervention-free survival at 6 years is less than 50% for patients managed with anti-impulse therapy. Data regarding this question are sparse, but two randomised trials (ADSORB and INSTEAD) both demonstrated a higher rate of favourable aortic remodelling in patients managed with TEVAR than medical therapy alone. However, it is unclear whether this positive remodelling translates into a reduction in long-term mortality sufficient to balance the early perioperative hazards of endografting. Despite increasing adeptness at endovascular stenting, the long-term outcomes of patients with ABAD leave significant room for improvement. In particular, the optimum management of patients with uncomplicated disease is unclear and guidance from trials powered for long-term mortality is awaited. Until then, the principals of management of ABAD remain aggressive medical therapy for all patients, with TEVAR primarily reserved for those who develop complications

  9. Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

    Directory of Open Access Journals (Sweden)

    Nicole Ulrich

    2015-01-01

    Full Text Available Introduction. Cervical artery dissection (CAD is a common cause of stroke in younger patients. While the incidence of stroke in pregnancy is increasing, CAD remains a rare cause of ischemic stroke in the pregnant population, with only 30 cases described in the literature, most in the postpartum period. Methods. The case of a pregnant patient at 18 weeks of gestation presenting with CAD and ischemic stroke following intercourse is discussed. Discussion. CAD results from an intimal tear in the carotid artery, allowing accumulation of blood in the vessel wall. Stroke results from embolization of thrombogenic material in the wall. Etiology includes minor trauma, connective tissue disorders, or anatomic variations of the carotid artery. Most patients present with headache and/or neck pain, while ischemic symptoms are seen in at least 50% of patients. In the pregnant population, imaging with MRI or MRA of the head and neck aids in diagnosis. Once the diagnosis is made, patients are treated with either anticoagulation or antiplatelet medications. The optimal treatment in both pregnant and nonpregnant patients has not been well-studied. Conclusion. CAD is an important diagnosis to consider in a pregnant patient with persistent headache, especially if neurological symptoms are present. Imaging should be quickly obtained so treatment can be initiated.

  10. Neck and shoulder muscle activity and posture among helicopter pilots and crew-members during military helicopter flight.

    Science.gov (United States)

    Murray, Mike; Lange, Britt; Chreiteh, Shadi Samir; Olsen, Henrik Baare; Nørnberg, Bo Riebeling; Boyle, Eleanor; Søgaard, Karen; Sjøgaard, Gisela

    2016-04-01

    Neck pain among helicopter pilots and crew-members is common. This study quantified the physical workload on neck and shoulder muscles using electromyography (EMG) measures during helicopter flight. Nine standardized sorties were performed, encompassing: cruising from location A to location B (AB) and performing search and rescue (SAR). SAR was performed with Night Vision Goggles (NVG), while AB was performed with (AB+NVG) and without NVG (AB-NVG). EMG was recorded for: trapezius (TRA), upper neck extensors (UNE), and sternocleido-mastoid (SCM). Maximal voluntary contractions (MVC) were performed for normalization of EMG (MVE). Neck posture of pilots and crew-members was monitored and pain intensity of neck, shoulder, and back was recorded. Mean muscle activity for UNE was ∼10% MVE and significantly higher than TRA and SCM, and SCM was significantly lower than TRA. There was no significant difference between AB-NVG and AB+NVG. Muscle activity in the UNE was significantly higher during SAR+NVG than AB-NVG. Sortie time (%) with non-neutral neck posture for SAR+NVG and AB-NVG was: 80.4%, 74.5% (flexed), 55.5%, 47.9% (rotated), 4.5%, 3.7% (lateral flexed). Neck pain intensity increased significantly from pre- (0.7±1.3) to post-sortie (1.6±1.9) for pilots (p=0.028). If sustained, UNE activity of ∼10% MVE is high, and implies a risk for neck disorders.

  11. Position of document holder and work related risk factors for neck pain among computer users: a narrative review.

    Science.gov (United States)

    Ambusam, S; Baharudin, O; Roslizawati, N; Leonard, J

    2015-01-01

    Document holder is used as a remedy to address occupational neck pain among computer users. An understanding on the effects of the document holder along with other work related risk factors while working in computer workstation requires attention. A comprehensive knowledge on the optimal location of the document holder in computer use and associated work related factors that may contribute to neck pain reviewed in this article. A literature search has been conducted over the past 14 years based on the published articles from January 1990 to January 2014 in both Science Direct and PubMed databases. Medical Subject Headings (MeSH) keywords for search were neck muscle OR head posture OR muscle tension' OR muscle activity OR work related disorders OR neck pain AND/OR document location OR document holder OR source document OR copy screen holder.Document holder placed lateral to the screen was most preferred to reduce neck discomfort among occupational typists. Document without a holder was placed flat on the surface is least preferred. The head posture and muscle activity increases when the document is placed flat on the surface compared to when placed on the document holder. Work related factors such as static posture, repetitive movement, prolong sitting and awkward positions were the risk factors for chronic neck pain. This review highlights the optimal location for document holder for computer users to reduce neck pain. Together, the importance of work related risk factors for to neck pain on occupational typist is emphasized for the clinical management.

  12. [Internal carotid artery dissection after laparoscopic surgery].

    Science.gov (United States)

    Martín-Mateos, Esperanza; Gómez-Ríos, Manuel Ángel; Freire-Vila, Enrique

    2017-05-22

    Headache is a common symptom in the postoperative period and may be attributable to, dehydration, sleep deprivation, intentional or inadvertent dural puncture during a neuraxial anesthesia technique, from an inhaled anesthetic agent, or from specific surgical procedures, among other etiologies. However, more serious, uncommon and life-threatening conditions as carotid artery dissection can be associated with severe neurologic sequelae in otherwise young, healthy patients. For these reasons, clinicians involved with postoperative patients should be familiar with the presentation and management strategies for this complication. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  13. Spontaneous Coronary Artery Dissection: Case Report Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kemal Karaağaç

    2013-03-01

    Full Text Available Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome with a high risk of mortality. The clinical presentation is similar to the atherosclerotic coronary artery disease. The diagnosis is usually made by coronary angiography. Spontaneous coronary artery dissection is more common in women than men. Fast and accurate diagnosis and treatment of spontaneous coronary artery dissection patients improves survival. Therapeutic options include surgery, percutaneous coronary intervention and medical therapy.

  14. Radicality effect of adding an interpectoral to a subpectoral approach for dissection of level III axillary lymph nodes in breast cancer.

    Science.gov (United States)

    Barros, Alfredo Carlos S D; Andrade, Felipe Eduardo M; Bevilacqua, José Luiz B; Barros, Maria Aparecida C; Piato, José Roberto; Santos, Donizeti R; Filassi, José Roberto; Nimir, Cristiane C B A

    2013-01-01

    The extent of axillary lymph node dissection for breast cancer treatment is tailored to each patient. When the surgeon assumes that full dissection, including level III, is needed, there are basically two ways for reaching the apical nodes while preserving the pectoralis muscles: a subpectoral approach, below the joined pectoralis muscles, and another that includes an additional interpectoral dissection between the muscles. We conducted a study to evaluate the radicality of dissection using these two approaches. To determine whether the harvest of level III axillary lymph nodes is equivalent with the different approaches, we prospectively studied 75 patients with breast cancer. Careful axillary lymph node dissection was done to as radical an extent as possible, first below the lateral edge of the joined pectoralis muscles (subpectoral approach) and sequentially after opening the space between the muscles (additional interpectoral approach). The number of patients with extra level III nodes retrieved by the addition of an interpectoral dissection as well as the number of complementary nodes obtained in such patients were determined. We excised 1701 axillary lymph nodes in 75 patients (mean, 22.7). Using first the subpectoral approach, we resected 259 level III nodes in 68 patients (mean, 3.8); in 56 patients, we removed 132 additional level III nodes using the supplementary interpectoral approach (mean, 2.4). In 7 patients (9.3%), we found at least one metastatic node with the interpectoral approach. Two of these patients had positive level III nodes that were discovered only by addition of the interpectoral dissection. The dissection of level III axillary nodes is more radical when an additional interpectoral dissection is performed after a subpectoral approach has been used. The exclusive subpectoral approach frequently leaves residual nodes at the apex of the axilla.

  15. Assessment of neck pain and cervical mobility among female computer workers at Hail University.

    Science.gov (United States)

    Mohammad, Walaa S; Hamza, Hayat H; ElSais, Walaa M

    2015-01-01

    The aims of this study were to investigate the prevalence of neck pain among computer workers at Hail University, Saudi Arabia and to compare the cervical range of motion (ROM) of female computer workers suffering from neck pain to the cervical ROM of healthy female computer workers. One hundred and seventy-six female volunteers between 20 and 46 years of age were investigated. Fifty-six of these volunteers were staff members, 22 were administrators and 98 were students. The Cervical Range of Motion (CROM) instrument was used to measure the ROM of the cervical spine. A questionnaire was used to assess participants for the presence of neck pain. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software, and the level of significant was set at p high prevalence of neck pain (75%) among computer workers at Hail University, particularly among students. There were significant differences in cervical lateral flexion, rotation to the right side and protraction range between the pain and pain-free groups. Our results demonstrated that cervical ROM measurements, particularly cervical lateral flexion, rotation and protraction, could be useful for predicting changes in head and neck posture after long-term computer work.

  16. Background Music in the Dissection Laboratory: Impact on Stress Associated with the Dissection Experience

    Science.gov (United States)

    Anyanwu, Emeka G.

    2015-01-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on…

  17. Doing Dissections Differently: A Structured, Peer-Assisted Learning Approach to Maximizing Learning in Dissections

    Science.gov (United States)

    Hall, Emma R.; Davis, Rachel C.; Weller, Renate; Powney, Sonya; Williams, Sarah B.

    2013-01-01

    Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning…

  18. Background Music in the Dissection Laboratory: Impact on Stress Associated with the Dissection Experience

    Science.gov (United States)

    Anyanwu, Emeka G.

    2015-01-01

    Notable challenges, such as mental distress, boredom, negative moods, and attitudes, have been associated with learning in the cadaver dissection laboratory (CDL). The ability of background music (BM) to enhance the cognitive abilities of students is well documented. The present study was designed to investigate the impact of BM in the CDL and on…

  19. Doing Dissections Differently: A Structured, Peer-Assisted Learning Approach to Maximizing Learning in Dissections

    Science.gov (United States)

    Hall, Emma R.; Davis, Rachel C.; Weller, Renate; Powney, Sonya; Williams, Sarah B.

    2013-01-01

    Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning…

  20. Changes in saccadic reaction time while maintaining neck flexion in the elderly.

    Science.gov (United States)

    Kunita, Kenji; Fujiwara, Katsuo

    2006-05-01

    We investigated changes in saccadic reaction time during maintenance of neck flexion in elderly individuals. Subjects comprised 49 volunteers, including 19 young adults and 30 elderly adults. Elderly subjects were separated into 2 groups (trained group: n=18; untrained group: n=12) based on responses to a questionnaire concerning activities of daily living. Saccadic reaction time was measured at angles of neck flexion of 0 degrees (resting position), 10 degrees and 20 degrees , with the chin either resting on a stand (chin-on) or not (chin-off). Reaction time was determined as the latency to the beginning of eye movement toward the lateral target, which was moved at random intervals in jumps of 20 degrees amplitude. In the chin-on posture, the angle of neck flexion had no significant effect on reaction time in any group. In the chin-off posture, the flexion angle significantly affected reaction time in both young and elderly trained groups. Significant shortenings of the reaction time were obtained at 10 degrees and 20 degrees neck flexion in the young group, and at 20 degrees neck flexion in the elderly trained group. No significant shortening of reaction time was noted in the elderly untrained group. These findings suggest that neural function associated with shortening of saccadic reaction time due to neck extensor activity decreases with age, and the decrements become more marked with inactivity in daily life.

  1. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  2. Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

    Science.gov (United States)

    Francque, S M; Van Laer, C; Struyf, N; Vermeulen, P; Corthouts, B; Jorens, P G

    2001-10-01

    A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.

  3. A computational phantom of head and neck - SISCODES

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Larissa; Trindade, Bruno Machado; Campos, Tarcisio Passos Ribeiro [Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares]. E-mail: larissa.thompson@ig.com.br; bmtrindade@yahoo.com; campos@nuclear.ufmg.br

    2007-07-01

    A computational voxel model of a head and neck adult male was built through the SISCODES code, in order to complement and to optimize the radiotherapic treatment in head and neck cancer, in terms of dosimetric evaluation and prediction. This computational simulator object, namely computational phantom, is a useful tool for the elaboration and simulation of the three-dimensional radiation planning. The present phantom was assembled based on information generated by photographic images of the visible human project. The images were digitalized and converted one by one to a matrix of voxel, in which tissues and its respective chemical composition were identified, with the helping of a biomedical and nuclear data bank including in SISCODES. A computational simulation of an external beam mimicking a Co-60 irradiator was prepared, reproducing a radiation window equivalent to one found in a lateral irradiation of a nasopharyngeal tumour in situ. Absorbed dose evaluation in the internal regions of the phantom are presented and demonstrated through spatial dose distribution, superimposed with the 2D phantom sections. The present article illustrates the possibility of generating information of the spatial dose distribution including all adjacent tissues, far from tumour, improving the radiodosimetry and creating the possibility of investigating neurological deficits, dysphagia, and speaking and hearing alterations, non evaluated in the present stage of radiation therapy of head and neck. (author)

  4. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  5. Head and neck position sense.

    Science.gov (United States)

    Armstrong, Bridget; McNair, Peter; Taylor, Denise

    2008-01-01

    Traumatic minor cervical strains are common place in high-impact sports (e.g. tackling) and premature degenerative changes have been documented in sports people exposed to recurrent impact trauma (e.g. scrummaging in rugby) or repetitive forces (e.g. Formula 1 racing drivers, jockeys). While proprioceptive exercises have been an integral part of rehabilitation of injuries in the lower limb, they have not featured as prominently in the treatment of cervical injuries. However, head and neck position sense (HNPS) testing and re-training may have relevance in the management of minor sports-related neck injuries, and play a role in reducing the incidence of ongoing pain and problems with function. For efficacious programmes to be developed and tested, fundamental principles associated with proprioception in the cervical spine should be considered. Hence, this article highlights the importance of anatomical structures in the cervical spine responsible for position sense, and how their interaction with the CNS affects our ability to plan and execute effective purposeful movements. This article includes a review of studies examining position sense in subjects with and without pathology and describes the effects of rehabilitation programmes that have sought to improve position sense. In respect to the receptors providing proprioceptive information for the CNS, the high densities and complex arrays of spindles found in cervical muscles suggest that these receptors play a key role. There is some evidence suggesting that ensemble encoding of discharge patterns from muscle spindles is relayed to the CNS and that a pattern recognition system is used to establish joint position and movement. Sensory information from neck proprioceptive receptors is processed in tandem with information from the vestibular system. There are extensive anatomical connections between neck proprioceptive inputs and vestibular inputs. If positional information from the vestibular system is inaccurate or

  6. The Effect of a Prior Dissection Simulation on Middle School Students' Dissection Performance and Understanding of the Anatomy and Morphology of the Frog

    Science.gov (United States)

    Akpan, Joseph Paul; Andre, Thomas

    1999-06-01

    Science teachers, school administrators, educators, and the scientific community are faced with ethical controversies over animal dissection in classrooms. Simulation has been proposed as a way of dealing with this issue. One intriguing previous finding was that use of an interactive videodisc dissection facilitated performance on a subsequent actual dissection. This study examined the prior use of simulation of frog dissection in improving students' actual dissection performance and learning of frog anatomy and morphology. There were three experimental conditions: simulation before dissection (SBD); dissection before simulation (DBS); or dissection-only (DO). Results of the study indicated that students receiving SBD performed significantly better than students receiving DBS or DO on both actual dissection and knowledge of the anatomy and morphology. Students' attitudes toward the use of animals for dissection did not change significantly from pretest to posttest and did not interact with treatment. The genders did not differ in achievement, but males were more favorable towards dissection and computers than were females.

  7. Behavioural laterality as a predictor of health in captive Caribbean flamingos (Phoenicopterus ruber): an exploratory analysis.

    Science.gov (United States)

    Anderson, Matthew J; Ialeggio, Donna M

    2014-01-01

    The present study sought to explore the possibility that lateral behaviour in captive Caribbean flamingos (Phoenicopterus ruber) housed at the Philadelphia Zoo (Philadelphia, PA) could be used to predict a variety of physiological measures of health obtained via complete blood counts (CBC) and plasma biochemistry analyses that were performed as part of the flock's annual physical examination. Consistent with previous research, evidence of rightward lateral neck-resting preferences were obtained, no evidence was found for the existence of leg stance preferences, and neck-resting and leg stance preferences were shown to be unrelated. Both lateral neck-resting preferences and lateral support leg preference were shown to be related to a variety of measures from the CBC and plasma biochemistry analyses. While several general trends emerged in regards to the CBC variables, the relationships between the lateral behaviours and those variables generated via plasma biochemistry analyses proved to be fewer and somewhat less consistent. Birds with rightward neck-resting preferences and birds with leftward support leg preferences generally appeared to be healthier and less stressed according to the CBC measures; however, the validity of lateral leg stance preference as a predictor of health and wellbeing is questionable given the lack of statistically significant leg stance preferences.

  8. Transparotid approach for mandibular condylar neck and subcondylar fractures.

    Science.gov (United States)

    Croce, A; Moretti, A; Vitullo, F; Castriotta, A; Rosa, De M; Citraro, L

    2010-12-01

    Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and/or the subcondylar region. Over the last 5 years, we observed 22 fractures of the condylar neck and 10 fractures of the subcondylar region. In 13 patients (11 male, 2 female, age range 10-68 years, mean 33 years), 10 of whom had other mandibular and/or other maxillo-facial and skeleton fractures - 50% of these with dislocated condylar heads - and the other 3 for their free choice, regarding the different treatments, 18 transparotid approaches with partial parotidectomy (bilateral in 5 cases), were performed reducing and fixing 12 condylar neck fractures and 5 subcondylar region fractures with appropriate plates (2.0 mm) and screws. After surgery, no intermaxillary fixation was performed. Complications included 4 salivary fistulae (bilateral in 1 patient), which closed spontaneously after 4 or 5 weeks with a dressing, 1 case of Frey's syndrome, which healed after 2 treatments with botulin and 6 cases of transient facial palsy lasting 4-8 weeks (1 case bilateral) affecting zygomatic, buccal and marginal mandibular nerves. During follow-up, functional parameters considered were: restoration of original pre-injury occlusion; vertical, lateral and protrusion mandibular movements. All patients re-acquired the original pre-injury occlusion; the maximal post-operative intrinsical distance was at least 40 mm after a variable period of rehabilitation and lateral and protrusion movements also led to satisfactory final results. All patients were free of pain and had no deflection or clicking upon

  9. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Hall, William H. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Li, Judy; Beckett, Laurel [Department of Biostatistics, University of California, Davis School of Medicine, Sacramento, California (United States); Farwell, D. Gregory [Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California (United States); Lau, Derick H. [Department of Medical Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Purdy, James A. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States)

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

  10. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain

    DEFF Research Database (Denmark)

    Juul-Kristensen, Birgit; Clausen, Brian; Ris Hansen, Inge

    2013-01-01

    To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls.......To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls....

  11. Laser versus dissection technique of tonsillectomy.

    Science.gov (United States)

    Ishlah, L Wan; Fahmi, A M; Srinovianti, N

    2005-03-01

    Tonsillectomy is the single most common operation performed in Ear Nose and Throat Department. Various methods of tonsillectomy have been practiced over the century aimed at reducing or eliminating intraoperative and postoperative morbidity. Due to various blood supplies received, intraoperative bleeding is the most difficult problem and securing it is time-consuming. The time taken to control the bleeding would invariably determine the length of operation. Common postoperative complications are bleeding and pain. This study evaluated the operative time, intraoperative blood loss, postoperative pain and other postoperative complications of tonsillectomy performed by laser as compared to conventional dissection technique. This is a prospective randomized study whereby sixty patients were divided into two groups of equal number. In one group, the tonsillectomy performed by laser and in the other group the tonsillectomy performed by conventional dissection technique. Operative time and amount of blood loss is significantly reduced in the laser group. Total postoperative pain and post operative complications were not significantly different between the two groups. Tonsillectomy by using laser have shown less intraoperative bleeding and shortened the operative time. In the hospital where laser machine and expertise are available, it is justifiable to use this technique as effective method of performing tonsillectomy.

  12. Speciation of Black-necked Crane

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Based on the concepts of species and speciation,the speciation of Black-necked Grane(Grus nigricollis) was discussed using bio-geographic principles and some evidences suggest that Black-necked Grane had a close relationship with Red-crowned Crane(Grus japonensis).The Qinghai-Tibetan Plateau uplift may be the most important factor in allopatric speciation for Black-necked Crane.

  13. Fusobacterial head and neck infections in children.

    Science.gov (United States)

    Brook, Itzhak

    2015-07-01

    Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults

    Institute of Scientific and Technical Information of China (English)

    Amit Aggarwal; Mahipal Singh; Aditya N Aggarwal; Shuchi Bhatt

    2014-01-01

    Objective:To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior (AP) view and also assess if the addition of lateral view changes the classification and management plan.Methods:Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan.Then the same films were reshown in conjunction with their lateral view after 10 days.Results were compared with respect to the classification and management plan between two groups.Interobserver agreement was calculated using Fleiss' kappa.Results:There was only a fair interobserver agreement (kappa value 0.39) on Garden classification on AP view only which improved to moderate agreement (kappa value 0.52) after adding a lateral view.While there was only a slight improvement in the interobserver agreement on the management plan on AP view only (kappa value 0.50) and AP combined with lateral views (kappa value 0.52).Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases.Conclusion:We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.

  15. Surgeon's view of the skull base from the lateral approach.

    Science.gov (United States)

    Goldenberg, R A

    1984-12-01

    This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed.

  16. Migraine and neck pain: Mechanisms of comorbidity

    Directory of Open Access Journals (Sweden)

    A. S. Zenkevich

    2016-01-01

    Full Text Available Neck pain and migraine are common diseases. Neck pain seldom occurs in a patient with migraine. However, the relationship between migraine and neck pain has been inadequately investigated.Objective: to analyze neck pain in patients with migraine to determine possible comorbidity mechanisms of these diseases.Patients and methods. The investigation enrolled 63 patients with chronic migraine (CM and 40 with episodic migraine (EM diagnosed in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-3. Winking reflex (WR and nociceptive flexion reflex (NFR were examined to evaluate the function of antinociceptive systems.Results. In the patients with CM, neck pain was more common than in those with EM (53.03% versus 14.02%; and panful tenderness, sensitivity, and tension of neck muscles were more marked. There was also a significant reduction in WR and NFR thresholds. Neck pain was noted to be an integral component of the pathogenesis of CM in a large number of patients with this condition. The authors proposed several pathophysiological mechanisms of a relationship between migraine and neck pain. Neck muscles and craniovertebral junction areas serve as a source for the arrival of nociceptive pain pulses in the central nervous system (peripheral sensitization, promoting pain chronization. Muscle dysfunction in this area may be, in turn, a reflection of central sensitization and impaired descending pain control.

  17. [Update on current care guidelines. Neck pain].

    Science.gov (United States)

    2009-01-01

    Neck pain is very common. Age, female gender, obesity, and several physical and psychological work related factors increase the risk while physical activity appears to decrease it. Non-specific neck pain is most common but serious or specific illness must be ruled out and neural compression identified. Patients are encouraged to remain active and improve their ergonomics. Acute neck pain often disappears without any special treatment. Paracetamol is the primary pain medication. Multidisciplinary treatment is recommended if disabling pain has lasted for two months, and intensive muscle exercises in chronic neck pain. Progressive muscle weakness and myelopathy indicate a surgical assessment.

  18. Shoot Branching and Leaf Dissection in Tomato Are Regulated by Homologous Gene Modules[W

    Science.gov (United States)

    Busch, Bernhard L.; Schmitz, Gregor; Rossmann, Susanne; Piron, Florence; Ding, Jia; Bendahmane, Abdelhafid; Theres, Klaus

    2011-01-01

    Aerial plant architecture is predominantly determined by shoot branching and leaf morphology, which are governed by apparently unrelated developmental processes, axillary meristem formation, and leaf dissection. Here, we show that in tomato (Solanum lycopersicum), these processes share essential functions in boundary establishment. Potato leaf (C), a key regulator of leaf dissection, was identified to be the closest paralog of the shoot branching regulator Blind (Bl). Comparative genomics revealed that these two R2R3 MYB genes are orthologs of the Arabidopsis thaliana branching regulator REGULATOR OF AXILLARY MERISTEMS1 (RAX1). Expression studies and complementation analyses indicate that these genes have undergone sub- or neofunctionalization due to promoter differentiation. C acts in a pathway independent of other identified leaf dissection regulators. Furthermore, the known leaf complexity regulator Goblet (Gob) is crucial for axillary meristem initiation and acts in parallel to C and Bl. Finally, RNA in situ hybridization revealed that the branching regulator Lateral suppressor (Ls) is also expressed in leaves. All four boundary genes, C, Bl, Gob, and Ls, may act by suppressing growth, as indicated by gain-of-function plants. Thus, leaf architecture and shoot architecture rely on a conserved mechanism of boundary formation preceding the initiation of leaflets and axillary meristems. PMID:22039213

  19. Juan Valverde de Hamusco's unauthorized reproduction of a brain dissection by Andreas Vesalius.

    Science.gov (United States)

    Lanska, Douglas J; Lanska, John R

    2013-02-26

    The objective of the present work is to examine images of the brain dissection by Flemish-born anatomist Andreas Vesalius (1514-1564) as originally represented in the Fabrica (1543), and later copied without Vesalius' permission by Spanish anatomist Juan Valverde de Hamusco (c1525-c1587) in Historia de la composicion del cuerpo humano (1556). Illustrations of the brain dissection in the Fabrica were obtained in digital form, resized, and arranged in a comparable montage to that presented by Valverde. Computer manipulations were used to assess image correspondence. The Valverde illustrations are approximately half the size and are mirror images of those in the Fabrica, but otherwise show the same dissection stages, and identical transverse brain levels and structures. The Valverde illustrations lack shadowing and show minor variations in perspective and fine details (e.g., branching pattern of the middle meningeal artery) from those in the Fabrica. Craftsmen under the direction of Valverde copied the woodcut prints in the Fabrica in close but approximate form by freehand engraving onto copper plates. Differences in the sizes of the images, and in perspective and fine detail, preclude direct tracing of images as the means of copying. Because engravings are in effect "flipped over" to make further prints, subsequent prints made from Valverde's copperplate engravings are mirror images of the prints in Vesalius' Fabrica.

  20. Development of a seminar on medical professionalism accompanying the dissection course.

    Science.gov (United States)

    Shiozawa, T; Griewatz, J; Hirt, B; Zipfel, S; Lammerding-Koeppel, M; Herrmann-Werner, A

    2016-11-01

    Medical professionalism is an increasingly important issue in medical education. The dissection course represents a profound experience for undergraduate medical students, which may be suitable to address competencies such as self-reflection and professional behavior. Based on a needs assessment, a seminar on medical professionalism was developed to parallel the dissection course. The conceptual framework for the teaching intervention is experiential learning. Specific learning goals and an interview guideline were formulated. After a pilot run, peer-teaching was introduced. Over three terms (winter 2012/13, 2013/14, 2014/15), an average of 129 students voluntarily participated in the seminar, corresponding to 40% of the student cohort. The evaluation (n=38) shows a majority of students agreeing that the seminar offers support with this extraordinary situation in general and also that the seminar helps them to become first impressions on how to cope with death and dying in their later professional life as a doctor, and, that it also provides them the means to reflect upon their own coping mechanisms. Although not yet implemented as an obligatory course, the seminar is appreciated and positively evaluated. Medical professionalism is an implicit aspect of the dissection course. To emphasize its importance, a teaching intervention to explicitly discuss this topic is advisable. Copyright © 2016 Elsevier GmbH. All rights reserved.

  1. Pertrochanteric osteotomy and distraction femoral neck lengthening for treatment of proximal hip ischemic deformities in children.

    Science.gov (United States)

    Teplenky, Mikhail; Mekki, Waleed

    2016-02-01

    Proximal femoral ischemic deformities in the pediatric population is a challenging pathological situation. Many surgical techniques have been proposed to treat this problem, with variable reported results. We believe that a C-shaped pertrochanteric osteotomy plus neck lengthening utilizing distraction osteogenesis principles would restore the femoral anatomical ratios between neck, shaft, and the head, and redress the biomechanics of the proximal femur with resultant sufficient containment of the femoral head within the acetabulum. We reviewed the results of 19 patients divided into two groups with proximal femoral ischemic deformities. Between 2002 and 2009, preoperative and postoperative clinical examination and radiographs were assessed measuring the neck-shaft angle (NSA), neck-epiphyseal angle (NEA), articulo-trochanteric distance (ATD), lateralization of the greater trochanter (LT), the angle of Wiberg (CEA), index of lateral head displacement by Reimers (IM), and lateral angle of displacement (LDA). All patients were followed prospectively. Clinical outcome was assessed using Colton's criteria, which showed average good improvement in function (58.9 %). Radiological indicators were assessed using Kruczynski's criteria. For group I, the postoperative NSA, NEA, and CEA showed significant change (p < 0.01, p < 0.001, and p < 0.001, respectively). For group II, the postoperative NSA, NEA, and CEA showed significant change (p < 0.001, p < 0.001, and p < 0.001, respectively). The midterm functional results are favorable for the implementation of pertrochanteric osteotomy and distraction osteogenesis to treat proximal femoral ischemic deformities in the pediatric population.

  2. Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index

    NARCIS (Netherlands)

    Reneman, Michiel F.; Geertzen, Jan H. B.; Jorritsma, Wim; Knol-de Vries, Grietje; Dijkstra, Pieter U.

    2012-01-01

    To investigate relevant change on the Neck Pain and Disability Scale (NPAD) and Neck Disability Index (NDI) and which questionnaire is the most responsive in patients with non-specific chronic neck pain (CNP). Seventy-six patients with non-specific CNP in an outpatient tertiary rehabilitation settin

  3. Fatal dissection of the descending aorta after implantation of a stent in a 19-year-old female with Turner's syndrome.

    NARCIS (Netherlands)

    Fejzic, Z.; Oort, A.M. van

    2005-01-01

    We report a fatal dissection of the descending aorta as a complication after a two-staged implantation of a stent to relieve aortic coarctation in a young female with Turner's syndrome. Implantation of the stent, with dilation up to 70 percent, and half a year later re-dilation to 100 percent, was w

  4. Dissection of the adult zebrafish kidney.

    Science.gov (United States)

    Gerlach, Gary F; Schrader, Lauran N; Wingert, Rebecca A

    2011-08-29

    Researchers working in the burgeoning field of adult stem cell biology seek to understand the signals that regulate the behavior and function of stem cells during normal homeostasis and disease states. The understanding of adult stem cells has broad reaching implications for the future of regenerative medicine. For example, better knowledge about adult stem cell biology can facilitate the design of therapeutic strategies in which organs are triggered to heal themselves or even the creation of methods for growing organs in vitro that can be transplanted into humans. The zebrafish has become a powerful animal model for the study of vertebrate cell biology. There has been extensive documentation and analysis of embryonic development in the zebrafish. Only recently have scientists sought to document adult anatomy and surgical dissection techniques, as there has been a progressive movement within the zebrafish community to broaden the applications of this research organism to adult studies. For example, there are expanding interests in using zebrafish to investigate the biology of adult stem cell populations and make sophisticated adult models of diseases such as cancer. Historically, isolation of the zebrafish adult kidney has been instrumental for studying hematopoiesis, as the kidney is the anatomical location of blood cell production in fish. The kidney is composed of nephron functional units found in arborized arrangements, surrounded by hematopoietic tissue that is dispersed throughout the intervening spaces. The hematopoietic component consists of hematopoietic stem cells (HSCs) and their progeny that inhabit the kidney until they terminally differentiate. In addition, it is now appreciated that a group of renal stem/progenitor cells (RPCs) also inhabit the zebrafish kidney organ and enable both kidney regeneration and growth, as observed in other fish species. In light of this new discovery, the zebrafish kidney is one organ that houses the location of two

  5. Chronic Neck Pain and Cervicogenic Headaches.

    Science.gov (United States)

    Feng, Frank L.; Schofferman, Jerome

    2003-11-01

    Chronic axial neck pain and cervicogenic headache are common problems, and there have been significant advances in the understanding of the etiology and treatment of each. The severity and duration of pain drives the process. For patients who have had slight to moderate pain that has been present for less than 6 months and have no significant motor loss, strength training of anterior, posterior, and interscapular muscle groups coupled with body mechanics training is prescribed. After 8 weeks, if the patient is better, exercises are continued at home or in a gym. If the patient is not better, physical therapy is continued for up to 8 more weeks. In patients with motor loss or severe pain, radiographs and magnetic resonance imaging (MRI) should be ordered at the initial visit. In patients with slight to moderate pain who are not better by 4 to 6 months, plain radiographs of the neck and MRI should be ordered. Based on the results, a spinal injection is usually prescribed. If MRI reveals spinal stenosis of the central or lateral canal, or a disc herniation, an epidural corticosteroid injection should be ordered. If the epidural provides good relief, the patient can be referred for more aggressive physical therapy and repeat the epidural as needed up to a maximum of three times. If there is no pathology within the canal, medial branch blocks and intra-articular steroid injections can be ordered based on the joints that are most tender or where disc space narrowing is greatest, or MRI or radiographs are recommended. If there is excellent relief from the medial branch block and joint injections, repeat when the steroids wear off. If there is good relief again, but pain recurs, medial branch radiofrequency neurotomy is recommended. For patients with one or two level disc degeneration that has not responded, a psychologic evaluation and discography is recommended. If there are no significant psychologic abnormalities, and one or two (rarely three) painful discs, surgical

  6. SMAD2 Mutations Are Associated with Arterial Aneurysms and Dissections

    NARCIS (Netherlands)

    Micha, D.; Guo, D.C.; Hilhorst-Hofstee, Y.; Kooten, F. van; Atmaja, D.; Overwater, E.; Cayami, F.K.; Regalado, E.S.; Uffelen, R. van; Venselaar, H.; Faradz, S.M.H.; Vriend, G.; Weiss, M.M.; Sistermans, E.A.; Maugeri, A.; Milewicz, D.M.; Pals, G.; Dijk, F.S. Van

    2015-01-01

    We report three families with arterial aneurysms and dissections in which variants predicted to be pathogenic were identified in SMAD2. Moreover, one variant occurred de novo in a proband with unaffected parents. SMAD2 is a strong candidate gene for arterial aneurysms and dissections given its role

  7. Cardiac tamponade – presentation of type A aortic dissection

    Directory of Open Access Journals (Sweden)

    Opeyemi Fadahunsi

    2014-11-01

    Full Text Available Acute aortic dissection usually presents with severe chest and/or back pain but may have a varied presentation ranging from syncope, stroke, and heart failure to shock or tamponade. We present classic chest computed tomography images of a case of type A aortic dissection presenting with cardiac tamponade.

  8. Spontaneous carotid artery dissection causing a juvenile cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Huebsch, P.; Schindler, E.

    1988-11-01

    The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

  9. Dissection Videos Do Not Improve Anatomy Examination Scores

    Science.gov (United States)

    Mahmud, Waqas; Hyder, Omar; Butt, Jamaal; Aftab, Arsalan

    2011-01-01

    In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College…

  10. An alternate dissection approach to the female urogenital triangle.

    Science.gov (United States)

    Hall, Margaret I; Walters, Linda M

    2013-09-01

    Traditional dissections of the female urogenital (UG) triangle can lead to early destruction of the erectile tissues, associated musculature, and neurovascular structures. Here, we present an alternate dissection of the female UG triangle. Rather than begin the female UG triangle dissection with the fatty tissue of the labia majora, we utilize an early identification of the suspensory ligament of the clitoris to organize the dissection. The suspensory ligament leads to the body of the clitoris, which can be palpated from distal to proximal to find the crura of the clitoris with overlying ischiocavernosus muscles. Once the crura have been defined, the bulbs of the vestibule with overlying bulbospongiosus muscles can be palpated medially and posteriorly. This dissection approach results in a clean dissection that well demonstrates homologies between male and female external genitalia. Through the use of this method, most student dissection attempts are able to demonstrate the erectile tissues and associated musculature that comprise the female UG triangle. This technique can also be used for male UG triangle dissections, encouraging identification of male and female homologies. Copyright © 2013 Wiley Periodicals, Inc.

  11. Dissection Videos Do Not Improve Anatomy Examination Scores

    Science.gov (United States)

    Mahmud, Waqas; Hyder, Omar; Butt, Jamaal; Aftab, Arsalan

    2011-01-01

    In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College…

  12. Outcomes of a Rotational Dissection System in Gross Anatomy

    Science.gov (United States)

    Marshak, David W.; Oakes, Joanne; Hsieh, Pei-Hsuan; Chuang, Alice Z.; Cleary, Leonard J.

    2015-01-01

    At the University of Texas Houston Medical School, a rotational dissection system was introduced to improve coordination between the Gross Anatomy and the Introduction to Clinical Medicine (ICM) courses. Six students were assigned to each cadaver and divided into two teams. For each laboratory, one team was assigned to dissect and the other to…

  13. Student Attitudes toward Cadaveric Dissection at a UK Medical School

    Science.gov (United States)

    Quince, Thelma A.; Barclay, Stephen I. G.; Spear, Michelle; Parker, Richard A.; Wood, Diana F.

    2011-01-01

    A more humanistic approach toward dissection has emerged. However, student attitudes toward this approach are unknown and the influences on such attitudes are little understood. One hundred and fifty-six first-year medical students participated in a study examining firstly, attitudes toward the process of dissection and the personhood of the…

  14. American Academy of Otolaryngology--Head and Neck Surgery

    Science.gov (United States)

    ... Neck Mass in Adults is now available in Otolaryngology–Head and Neck Surgery. The guideline addresses the ... Interested in systematic review training? SAGE, publisher of Otolaryngology—Head and Neck Surgery , will offer three grants ...

  15. Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

    Directory of Open Access Journals (Sweden)

    Popović Rade

    2016-01-01

    Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

  16. Internal structure of the cerebral hemispheres: an introduction of fiber dissection technique Estrutura interna dos hemisférios cerebrais: introdução à técnica de dissecação de fibras

    OpenAIRE

    Igor de Castro; Daniel de Holanda Christoph; Daniel Paes dos Santos; José Alberto Landeiro

    2005-01-01

    The aim of this study is to introduce the fiber dissection technique and its importance in the comprehension of the three-dimensional intrinsic anatomy of the brain. A total of twenty brain hemispheres were dissected. Using Kingler's technique we demonstrated the intrinsic structures of the brain. The supra lateral aspect of the brain as well as the medial aspect were presented. The most important fiber systems were demonstrated. The use and comprehension of new neuroimaging techniques demand...

  17. Wall stress of the cervical carotid artery in patients with carotid dissection: a case-control study.

    Science.gov (United States)

    Callaghan, Fraser M; Luechinger, Roger; Kurtcuoglu, Vartan; Sarikaya, Hakan; Poulikakos, Dimos; Baumgartner, Ralf W

    2011-04-01

    Spontaneous internal carotid artery (ICA) dissection (sICAD) results from an intimal tear located around the distal carotid sinus. The mechanisms causing the tear are unknown. This case-control study tested the hypotheses that head movements increase the wall stress in the cervical ICA and that the stress increase is greater in patients with sICAD than in controls. Five patients with unilateral, recanalized, left sICAD and five matched controls were investigated before and after maximal head rotation to the left and neck hyperextension after 45° head rotation to the left. The anatomy of the extracranial carotid arteries was assessed by magnetic resonance imaging and used to create finite element models of the right ICA. Wall stress increased after head movements. Increases above the 80th and 90th percentile were located at the intimal side of the artery wall from 7.4 mm below to 10 mm above the cranial edge of the carotid sinus, i.e., at the same location as histologically confirmed tears in patients with sICAD. Wall stress increase did not differ between patients and controls. The present findings suggest that wall stress increases at the intimal side of the artery wall surrounding the distal edge of the carotid bulb after head movements may be important for the development of carotid dissection. The lack of wall stress difference between the two groups indicates that the carotid arteries of patients with carotid dissection have either distinct functional or anatomical properties or endured unusually heavy wall stresses to initiate dissection.

  18. THE COURSE OF DISSECTING ANEURYSM OF THE AORTA

    Directory of Open Access Journals (Sweden)

    N. A. Kosheleva

    2016-01-01

    Full Text Available Research objective. To define features of a course of dissecting aortic aneurysm now.Materials and methods. 11 clinical records of the patients with the established diagnosis of dissecting aortic aneurysm who have come to Regional clinical hospital of Saratov for 2015 are analysed.Results. Along with traditional risk factors, such as the male, existence of arterial hypertension are revealed also additional risk factors, in particular, regular heavy lifting. Gender features in localization of dissecting aortic aneurysm are defined: at men more often of dissecting aortic aneurysm of an aorta is localized in the abdominal aorta, at women in the thoracic region.Conclusions. Additional risk factor of stratification of dissecting aortic aneurysm in the thoracic region at women is the systematic raising of weights.

  19. Transanal total mesorectal excision: dissection tips using 'O's and 'triangles'.

    Science.gov (United States)

    Bernardi, M-P; Bloemendaal, A L A; Albert, M; Whiteford, M; Stevenson, A R L; Hompes, R

    2016-11-01

    Transanal total mesorectal excision (taTME) requires specific technical expertise, as it is often difficult to ascertain the correct dissection plane. Consequently, one can easily enter an incorrect plane, potentially resulting in bleeding (sidewall or presacral vessels), autonomic nerve injury and urethral injury. We aim to demonstrate specific visual features, which may be encountered during surgery and can guide the surgeon to perform the dissection in the correct plane. Specific features of dissection in the correct and incorrect planes are demonstrated in the accompanying video. The 'triangles' created using appropriate traction can aid in performing a precise dissection in the correct plane. Recognition of features described as 'O's can alert surgeons that they are entering a new fascial plane and can avoid incursion into an incorrect plane. Understanding and recognizing the described features which can be encountered in taTME surgery, a safe and accurate TME dissection can be facilitated.

  20. CrossFit-related cervical internal carotid artery dissection.

    Science.gov (United States)

    Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

    2015-08-01

    CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients.